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` , SL*L'.1=;' EI�iDE\*CE THA: F� i /���� <br /> 4L IP�tENT <br /> CC:.:P?,IES t��I1'fI THE S;aivD,�P,DS OF 3/•2��� <br /> THE U::DER�'r RITERS' I��BORATORY. <br /> :-':�?.^_CTIOi�I OL' 5:G\' ��L:CUIRF'� <br /> :"�:,..: LP.�CTIODi, • <br /> GALL 259-87�}5 FOiZ L�;SPr,CTION, � <br /> ' Datc <br /> - �__ <br /> APPLICATION FOR j;s� .�t � '-•� � �, : . , <br /> , <br /> i <br /> The undersiGned owner hereby agrees to hold and save ha.m;es� t:,e Citv � <br /> ei iJ.erett irom any and all clzimc for C:8M3oCS that may :trise hecause of <br /> instaLation of the improvemenY nereto apniicd for, and iuri'r.�r a�rees tc <br /> remoce same upon r.otice irom the City ar.d to rep.ace all r�.ablic propert:• <br /> dar.;ahed the:eby. <br /> ' VALUE: -,_, ` - , <br /> CII2CUITS: <br /> ' I <br /> � ���1»r> �„_,"�n�%'�� - �- �1.�« . i <br /> �� <br /> 3 u ��A�r.� G - o.f� . K�-�- `s.l�l.G�.��.�....�. <br /> � ����„v 3 -3 7S- <br /> Signed .: , , <br /> � � — <br /> Own e r <br /> � � - � • _ �t � <br /> Contractor <br /> - 1 , . . . l;; �''� i - - - _ _ <br /> ` ` G.-. � .. '�.' 1..�'4 _ � <br /> II <br /> _�....__ I <br /> �I <br /> i�� <br />