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THE UTY OF EVERE-i f <br />Date _ <br />Sketch of Proposed Sewer Connection for Bullding Situated on Lot_ <br />Division or Addillon__ �]' '� �• Zg•+ - Block <br />- - -. --- <br />No. _ ' 1-L7_Owned by <br />Application and Connection by-- <br />00 <br />nemarks:_ - -- � �- `- - - -�- -- — �O !� iec. #--�! �y <br />Depth of Se•.er at Connedlon � I �6//K 1•� i�%J� /'._ l.. / C I <br />4" �ww t' 4 -v^vf A-.t <br />41I Q? A es P+. / i&- <br />Connection made the � _-day of - LL&U, _ _ .196 � . Examined and Approved by <br />- )IL_ ._ Supt. of Streets and Sewer, B., <br />--- - - Inspector 27846 <br />i <br />Gry Lopnear <br />a <br />