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THE CIT ' OF EVERETT Date <br />—� Block t/ n <br />Sketch of Proposed Sewer Connection for Building Siittuated on Lot --- <br />Division or Addition <br />No.__ - r� �_l f owned by — <br />Application and Connection <br />Remarks:_ <br />Depth of SewOr at Connection I <br />Go <br />Conne <br />insp�o, <br />r,<,;.. . 15295 <br />_.Licensee <br />