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The Ur.d;rsigned _ <br />Hereby applies {or permission <br />At thr foll,wing location <br />� <br />� ' �—��'i— _�� <br />_'...__..._._L __. . . <br />! SKETCH <br />i IWork to be doncl <br />L_"_'_'--' ---'— <br />' r,. � <br />" .; 'l-/ • � `� <br />i—'I.' �L��•�'i )IZ".t=.. I' \. —_ <br />._ _ '� �,�ITf} <br />�. � .�__ii,,.._-�, <br />C- <br />i %�%%— ���.� ... �.. .. . � <br />'�� <br />Approved <br />.'r._' `',i _ _ i_.' "_'_"_' <br />I � . .... ..... .. .. .. � <br />i� <br />I <br />�- �� �' .�;' � ,k' C=. _ T <br />�. <br />, , __ , � <br />j//' , _� � . �,- - <br />�`!! "'e'�U'---._._ I. . _ y� i///�i ' ^ _ �_ ---` , �/%� <br />� � A - -'�/,tiiJ, -- ' . " G,t , �.- _ <br />I c. <br />J <br />� , <br />II I I"L I <br />� <br />7he undersigned ownen c�reby agrees fo hold and savc hormless thc Cily of <br />Evermt Iwm any and all claims br dmnages �hat may arise because of ihe <br />inslalloiion and mainlcnance ol Ihe ir.�,provement herclo applicd (or ond <br />lurlhcr ac�recs �o rcmovc samc upon notice Iwm ihc Cily ond to replacc all <br />public properly doma�ed Ihcreby. <br />� . � � ' �� � . . <br />Inipeclor's Sipr.o�ure - <br />��]�0 <br />Remarks <br />u <br />! �3 <br />� <br />va��o�« e�a�,�«,� <br />Yes <br />No <br />i <br />� <br />G�.�" f� i ' . <br />C ' I�7� ' �'/a.� /y�'! Jr �i /i <br />_♦ ' Signalme o/ Applim f �� <br />NV �� � <br />n� � )�.'i . <br />M �. , _ <br />Ad�lreas 1 <br />J� ' !. � � ., � <br />, v c� <br />� lelephono Number <br />Dum <br />t� L'_ �; r-.— - _ <br />FCO <br />i�mr nrrk�,vnis <br />Engincrtt , -- <br />Walc. ... ' — ' i' • <br />._.. -- — S�rect _ . <br />Comnwncotiom ��� <br />Traf!it ----- <br />_"__' Plm�riinp ___—_ <br />