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PROJECT NAME: N/ -rsyN 4,11, PROJECT NO: 7c,7
PROPERTY ADDRESS: __L o i 7 7 IE 7.31 Me21I 7CImAc-�-- DRAWING NO:
MAIN LOCATION:EEASEMENT _ 117,e5,aDATE INSTALLED:M/f"i2c/+C,'?,cx
PROPERTY OWNER NAME: MH TO MH LX34-
PROPERTY OWNER ADDRESS:MAIN STATION:
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CONTRACTOR: 72ay /3 �z ex s CONNECTION ®MH:
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INDICATE TYPE OF LATERAL BY CRO_SING OUT OTHERS FOR C0,4NC-C7:0:, TO MANHOLE. CHECK ABOVE.
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LIST QUANTITIES FOR PAY ITEMS HERE:
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l DMSION OF PUBLIC WORKS
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REPRESENTATIVE
CO. NAME:
GRAVITY SEINER SERVICE
CONNECTION SHEET
JANUARY 1999 S-13.2