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SK[TCH <br />(Work to be donel <br />�\ <br />�, <br />`; (,�D/�.:;:,�;'� <br />Y, _ <br />rJ =:�! cY. E I O <br />, 7'N/ % �<J <br />.uaY6a <br />S T��� !, <br />The undersigned owner hereby agrees to hold and save harm�ess thc City of <br />Eve�elt from any and all daims for damages fhat may arise because o( ihe <br />inslallalion and mainlenancc of Ihe improvenient hcreto applied for and <br />furlher agrees to remove same upon nolice irom the City and lo replace all <br />public property damaged Ihereby. <br />If'� <br />I,�� i'b�/"�'F �� <br />i ��J��?� / . <br />' +'r; <br />u'. , <br />,,-" � � �. <br />`=�o, <����/ �_ . :.�a•-:.c�/tl� <br />Insp=�ignafure � <br />�/: /� <br />Dafe � <br />Remarkz <br />! �.�.�.�.���....... . .. <br />,<o �� y i3 � <br />�5' iJr,i�T�/ <br />" NU'i'� <br />CHECK WITf-I l'IATER <br />DEPT. fOR 1"!.4TER LINE <br />LOC'ATIOidS C�FORE [XCAVATION <br />t�nn��ii�E Fop_._ . �,_ <br />Pi:O, ,-,-; D^,41NAGE. � <br />--� � <br />�,c n�Q�_�_._Ccnarr�uuScq��a;�, <br />� ` <br />� r• <br />� p �� � �\ ? )1 l � �-/j 7' i /� <br />/ 1 <br />y�O�rJ�� , TJ-a%��;�. J�G'.A- .a <br />� ` �O { ] <br />LO ]r1 �T O JI :> > i )) / �� 1 , <br />Cc �' I'� E' )- <br />,�`-�� <br />, � <br />l'}�il,T;ti� //✓G.. <br />���N'! EG . . <br />- c����v'��.��; ��- <br />� <br />Gt� ,��<- ��n.�P. G ii✓c _�� <br />��'N L TEL , G�� . j � �, , ,-',�; '. <br />/1�/���/�i'-'�'?';Ol�� �E: <br />Ft' ,L' �Cr;=/G PEGC�—�� <br />C C_ :'-:'i� �c' .. ,-�c- �::;,� . J <br />Variancc Required <br />Yes. _.... _. _ _ _...._...... <br />Na_ .. ............_.. <br />Cy� �;:a _ ��c�. z�� <br />� -- <br />/7/i,VN.4 �JTa'N�RAL � ON S %. Cti . <br />$ignnfure of Applimnf <br />.r7iG .s, r. .i-� rir <br />TlRrG./Li✓/7 �f.'�TlrO/V �%2G�- <br />�dress <br />�33 —C 1�d _ <br />ielephone Number <br />Dafe <br />� �_-�• �/ <br />S �, G� - - �, ,. . <br />Fee �:`-T�'��� <br />�. �Jln r <br />_ __�(= �!' <br />DEPT. APPROVAL( S _ <br />�J� y/)�� �� <br />Engincer � + �""'' "`�'� ai1'- -- <br />i / <br />Waler � � <br />Street A � '�"�� <br />. ` <br />Communicafionsy `� � �' <br />Traffic /J �a , <br />Planning �y� - <br />, y, <br />