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n <br />THE CITY. OFppEVERE-7T Date <br />Sketch of Proposed Sewer Connection for Building Situated on Lot_ /?"j l ' O " <br />Division or Addition----.. lu <br />� L <br />No .� .3 �-' Glkr C C ! / -re Owned b/ /7" <br />Application and Connection by_ c 4 11f s«¢1 <br />- -- ----- -- -- - — Licensee <br />Remarks:__ <br />