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, '` l <br />AFiLICATIUN for <br />Date � ��� � � � �� `/ <br />lJ�.S �Y,j� �J L C�x iC i L-) <br />?hn utdoraigned ouner 4crcbq ugreca ta hold at�d eacc� Ula�eloea the City of <br />Er�rott Prwn a�y and a11 claims far damagoo that mqy arieo boasuee of <br />inste�ilnti� of the iuprowmont hnreto applied for� end itu�ther egreea to <br />romove aema upon notice froa tho Citq and to roplaco all pub�ic proporty <br />damqpeci thoret9� <br />� �� <br />� � ���� � <br />�����,� j <br />i <br />dC E A'��•fl �•N � fJ ����1� �N �, / <br />�o�alion Approved�� :� <br />IIXpBC�Cd - ------....... <br />yo��a y' �os, !� �� c.r� Gti1C� �ivG. � L�Sfc�' <br />� �����l�i�, l�✓�"""� 1�•�' <br />J31Qnedl p�r <br />3igned <br />G,t; ' . • , , �, , ,,.1._ <br />��<���'"� <br />o k . 6� �J, `�".:"` <br />OX�vl il,�a:lclzl� <br />f L �g64 <br />p�, _�..�. <br />..IJ�a9°t <br />Apy}tOVED .... ....... Cl�: <br />.. � r:�tv <br />��,......,. .. <br />