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he Undersigned � ' _=___ � ' _ .' � � Date Apprcved <br /> Hereby applies for permission to ' � � i <br /> i j . <br /> Af the following location— ' r ' �� " � r` � c` <br /> � <br /> SKETCH <br /> IWork fo be donel � <br /> �f� <br /> - ---- , _------�___, __ r _____ - <br /> � � --- � <br /> � � �. <br /> � � � �� �-- o � <br /> � � o . _� � L <br /> o � <br /> .e <br /> � �� ZS <br /> ___ _ -- , . <br /> � % � <br /> i r� � <br /> ; •.� � <br /> <� d <br /> ,��� 2 <br /> 0 �� <br /> `�� v � <br /> --------._ ��; � <br /> � � —�� ---��--- --.� <br /> The undersigned owncn c�reby ogrees fo hold and fove hormless Ihe Cily of Voriancc Required <br /> Everelf from ony ond oll cloims lor damages Ihot moy orise becvuse ol Ihe <br /> installotion and maintenonce o( Ihe improvemenl here�o applied (or and Yes <br /> furlher agrees lo remove same upon no�ice Irom the Ciry ond lo replace all Na <br /> public p�oper�y damaged Ihereby. � <br /> $iynolure ol Applic�nf <br /> 1i <br /> � Address <br /> Telephone Number <br /> � ' . ��, Dala <br /> Inspeclors S�nalura , <br /> � � ��/% i� r' li' <br /> 9 Fce <br /> Date ---� -- <br /> DEPi. APPROVAlS <br /> Remarks �----------- --- <br /> En�incers <br /> __ Wafer�� :��� � i. /�!� 4 � L�I- <br /> —__—.___—.__----- —___—__ Strcet � <br /> Communimlions �i�i I i � <br /> Traffir. ,. <br /> — — -- Plonning <br />