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THE C ,TY OF EVEREI = Date- <br />-,-A _, 7..1 j Block <br />Sketch of Proposed Sewer connection for Building tW <br />Division or Addition <br />7� )- i ? — -- —Owned by. <br />No._— n <br />W-11011 -- — <br />Application and Connection by <br />[/i-- - __ Licensee <br />Remarks: I <br />Depth of Sewer at Connection I I <br />J I <br />Connection made the <br />r <br />r, <br />M <br />day of J -- <br />_19 _—.. Exam.ned and Approv d by. _1�1.w!/'��— <br />fii___�l �I / icIy E0910nr <br />.P <br />e Supt. of sif"te and Sewers By - --- -- - <br />3y iaepeetor 19758 - <br />