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'kQ1 THE CITY OF EVERETT <br />Date <br />7"Prod S <br />poseewer Connection for BAlding Situated on Loty <br />—� -Block— <br />No.3G / <br />Division or Addition <br />G/ ✓ <br />Application and Connection by <br />Remarks:.^____� w <br />J <br />Depth of Sewer At connection <br />Connection made the_A.--day of <br />By <br />Owned by G, y <br />Licensee <br />