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� y l .•E ;y y. Thy <br />1r13l,Jr�j 1 to <br />,tii TIC Block-- <br />-- - - - - - - - - - - <br />------- -- s -�--- <br />Slcetch of Proposed Sewer Connec ion or Wilding Situated on Lot__ ^ - <br />- ------------- - <br />. Qom.{�.�� �:---- -= •- - =------------------- <br />Division or Additimi____ <br />--- owned by <br />-�--1 ____- _,,,. � Licensee <br />Application and Connection by____� <br />--------- <br />-------- <br />--- <br />Romarlcs--------------------- ---------------- <br />Dcpth of Sewer at Connection <br />Connection made thi <br />ti3 07_ Jt^ y <br />2191.E <br />-_ 111% of Streets and Sewers <br />[Si4.__Inspector. <br />V <br />Examined and Approved by___ <br />K <br />OGk Z) <br />I <br />j <br />City engineer. <br />