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l'"HE G�TY OF EVE�l�ETT <br />��"'��� of Proposed Sewer Connection for Buildiug SiWated on Lot__1�-_' � <br />- ----- Block----=- --- - --- <br />Division or Addition________ _,'_, �r�_ <br />_ _ ---- -- <br />; � , � � -- -- ----- <br />No._=�- -- -----=- - Owned by ._J _ �� _ /i.o/%•^ � j��:rG/ — - <br />-- - _�--- - - � � - _-.. <br />Appiication and Connection by _________� . • ;____ _ ✓ ,' r- <br />---- --- ___Licensec <br />Remarks ; <br />------ ------- _-- <br />_ _ ----- -- ----- <br />Deptli of Sewer a� Conncctiun I � I � <br />I <br />- — --- - ' � '� <br />-------- ,. <br />_- --- <br />__---- -- _...__ __ - _. , _. <br />I � ��Y _____ <br />1 I <br />� <br />s� <br />I <br />_- % �` <br />� w i <br />. .. <br />I <br />_ . .. ___ i �..' . <br />. .._ . ...__ <br />I � _. <br />� o. � �+--- — � � I <br />Connection made the _` � day of �� �!��_______192_ Examined and Approved by_____________,_ �' <br />. Cliy E:pginecr. <br />---------- . ----Supt. of St:eds and Sewcrs. gY---- ----------- <br />Ey--_. . __'___—_____ _ _._.._—___. __ _—._..__ Inspccior. , . � �., . .'. �c...� <br />