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THE CITY OF EVERETT <br />Date <br />Sketch of Proposed Sewer Connection for Building Situated on Lot —4--�__22e -:1 I <br />Division or Addition__ /'r,_�'� S �is f 41111 <br />No._ _ ✓;`_ i!!. ;� . — — —Block <br />Owned by - <br />Application _��.ir[.... <br />Application and Connection by. !�'+'Y s4 / .. . � p Remarks:-----. <br />Depth of Serum at Connadlon � I <br />Connection made the. <br />BY. <br />day of <br />19 <br />5apt. of Streets and Seweu <br />Inspector <br />Examined and Approved by__ / ( uii.' <br />_ cityEngineer <br />