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THE 0_1 A r OF EVERETT Date <br />Block — <br />Sketch of Proposed Sewer Connection for Building <br />' Situated on Lot,. <br />-�- �-_ -- � <br />z <br />r c ri 1,1-�' <br />Division or Addition__--. - Sp� r9 <br />r i- - - / I —owned by__01 <br />No.— i.tcensw <br />ur , <br />f crlrY <br />Application and Connection by Remorks:♦ <br />�7 L Y JS r <br />_. �/t/J•i irr•o SurG� <br />Depth of Sewer at connection <br />t <br />ri:.jj h <br />d <br />7 <br />Connection made the_ -t—day <br />h <br />TtI v n I Tz ch <br />Im <br />t �A yy7.s <br />b Ay i City E <br />.19 3Y• Examined and Approved Y- Cfry Engineer <br />Supt. of Sheets and Sewers By_ -- <br />- _-inspector <br />1P446 <br />