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THE Ci ,'Y OFEVERE'T <br />Date_ <br />Sketch of Proposed Sewer Connection for Build' q Situated on Lot_fr, jU 9 1Z <br />�—y-- Block____/ <br />Divisiou or Addition_���n <br />—Owned by- r�---- -- <br />Application and cCol <br />Depth of Sewer at Connection I <br />Licensee <br />I <br />Connection made the._._4-_f �4_day o�- 19�. Examined and Approved by--���1 <br />/R¢¢,r..li. i. T <br />--- — - 1 -1 4— City Engineer <br />Air!. of Streole and Sewors By 2t_:iZ 11j G�( <br />By <br />Inspector (/� 1 /� _ <br />tiI Yl.524 , <br />