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� • .. . . . r�pprovra c;. . ^� <br /> �, • � , ' <br /> The Undersigned • �-%'� � 6'�--� � �, r Date Approved <br /> V / / <br /> Hereby applies for permission to �l � � � �, �% =�-' i ' - - � <br /> /� � �.� - � <br /> ,'�% . f�:,7 .� .71:� �. <br /> � ` . / , ; ' .. � <br /> Af the following location ��-/1 � _- '��.�c�r,,; , <br /> � <br /> _ �_---�-_-_- <br /> SKETCH �---"-- --�, <br /> (Work to be donel — � �� j <br /> �� <br /> '/� <br /> � <br /> '------ <br /> ` �_ • _ <br /> . , i <br /> j7,� �i�� a++ <br /> .�� " <br /> _- / �? <br /> C�l <br /> C:? � <br /> � <br /> The underzigned owncn c�reby agrees Io hold ond save harmless the Ciry of Variance Required <br /> Everel� trem any ond a!I doims for damoges thot may arisc because o( thc Yct_.._ � <br /> _.........._._.... <br /> i�isrolla�ion and mointc�.iancc of the improvemeN hereto applied for and <br /> (urlher agrees lo removc same upon nolice from the City and to replace all No_._._....__....._..-. <br /> public properly damoged thcreby. <br /> ' //� �/ <br /> ,.��/ . .,'cn �:.(`.}i V' �.7 :' <,/ , <br /> 'Signal(fre oI Applicanf � i <br /> 7 i J ��' <br /> /�� <br /> Addresi <br /> ���H - u /�S�Z J� _ <br /> Telephone Number <br /> _/ — � Date <br /> � <br /> :' �I t G�--'' (r �?. <br /> fnspecfor i Signalure �J <br /> ��� � �C'� Fee <br /> Dafe <br /> DEPT. APPROVALS <br /> Remark� Enginecrs '� � <br /> Waler � i:��1-- i.''ia.w. G�i <br /> Streel ��f 4' F " <br /> � <br /> Communicalions�-—� - <br /> Traffic � �r ,�_...__ <br /> Planning ,r /t' <br />