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THE UTY OF EVEREI F g ` <br />Date <br />Sketch of Proposed Sewer Connection or Building Situated on Lot_3 �y �° r ��' Sr <br />Division or Addition—> 1�,. +r �y _Block <br />Owned <br />Application and Connection <br />Remarks:_ <br />Depth of Sewer at Conneenon <br />I I <br />IS '71 <br />N <br />Connection made Lho .v- G-__day of..— �? tc� 19- . Examined and Approved by_�A) <br />City Sagineer <br />-------_- Supt. of Streets and Sewer By <br />*�—_.----------lnspWor 27992 --.. <br />