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The Undersigned �� �� c+ 4� r_ c� M._? ���_p] _ <br />=�'L �� �� � �1/� <br />—i —f4-- -- <br />' Datc Approved <br />Hereby applies for permission fn e o" :� r„ -�-.�� (! ��. �_�f d�f e h.l 5 irio �, �n 1 �< .S � X�J' S� _ <br />AI Ihe following localion �o� ��' �i _�L'SL4?�!A �°.��.+n . <br />..)— <br />SK[TCH <br />IWurk to be donel <br />ll lD 9 <br />��528 � <br />I � <br />-- — i <br />I I <br />_�' ��__ I <br />_ _ .— - <br />I:�rre..�.���cp� - . _ .. . <br />aevev-(,y <br />Thc undersigned ownen c�reby agrces to hold and save harmless Ihe City of <br />EvereH Irom any and all claims for damages Ihat may arise because o( ihe <br />insfallation and maintenance of Ihe imp�ovcinenl herelo applied for ond <br />lurlher agrees lo remove same upon nolice from the City and to replace ali <br />public property damoged �hereby. <br />Inspecfor i Signafine <br />._�/T/� h//- .CF/) C-.fU 7� <br />Dafe • <br />Call Engincering pept. ?�9 �NO3 <br />24 Nouis be(ore <br />cons!rur.tir.n is staried. <br />61��, <br />PROVI�E FOR <br />Ff70P�r' DRAINAGE <br />. �� <br />-')� <br />� '�`1 . 1 �_ �0 <br />V <br />Variance Requirec <br />Ycs <br />No <br />'' ,' ' i _ � �-.}[a PSE.�/ <br />.), /,�� � ,JJ �c�: ��.. r,�. <br />� $ignahre o/ Applica � <br />��.r��.�'�� i �='C,--� <br />Address <br />.E!/r��r7� �%4. <br />Telephone Num6er <br />Dale <br />s �(/O /=,�=� <br />Fee <br />DEPi. APPROVAl/S <br />Enginccr5" � �dCe�'�"�OI ��--' C�/Ji <br />Waler . w"^'� �' J.•wr� 6 = 7- �'/ _ <br />Slrect __ — ---' - � <br />Communimiions�: ' �_ ; � ;�' "�- %� <br />y i -, , <br />Tra(fic � `' ' � <br />Plannin��.r.�(�( s-�' <br />.. ��7E <br />^� ��-"K WITN WATER <br />� rt !'.'nTCR LINE <br />� � ��:r��: e.<r,nVtiTR1R <br />