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EVERE-, r <br />(r�':�4'HE CITY OF <br />A Is Date - <br />Sketch of Proposed Sewei Connection for Building Situated on Lot <br />—.—Block <br />Division or Addition- ---Owned by --"—'- <br />No <br />Application arto Connection by— <br />Remarks:- <br />m a <br />Do of SOW61 at <br />avv" <br />e 441- cd - <br />F <br />p, <br />% l9LExamined and Approved by-, cey E0t <br />Connection made the day of — <br />Supt. of Sif"Is and S*Wers BY - <br />Inspector <br />29301 <br />a <br />