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At fhe following localion <br />SiCETCH <br />IWork to be donel <br />� <br />V <br />W <br />w <br />The undcrsigned owner hereby agrees lo hold and savc harmless the City ef <br />Everell irom any and all claims for damages thal may arire because of the <br />installation and maintenance of the improvement hereto applied for and <br />(urther agrees to remove seme upon nolice (rom the City and lo replace all <br />public property damaged Ihereby. <br />Inspecfor's $ignalure <br />. <`�ri- �,�,_>—�,�ro 3 �24�i� <br />.�o�e <br />Remark: <br />�, ;i�� <br />i� �r!iTFI WATER <br />��.�1TC:R LI{`!E <br />��1R� EXCRVi�TION <br />i i� � <br />`�����- ���, <br />`" � <br />� ": _ . __ _ ... <br />� � ..�. . .. I l"i <br />� !' �Jr�F; i?;�rUi'�,�Gi. <br />i <br />___ _ _ ___ <br />���- , <br />�_, � <br />��No s—c��E <br />Variance Required <br />Yes... _ _... _....... _. _.... <br />No......_..._._....._.... <br />� � i. . <br />yr �� i� A i!� �t/.,'{'n <br />Signafure of Ap il cant <br />9i.Z9 ��...�,rs,_ �,�,._,,,_1�',.�_-�' <br />N�da��5: <br />,��`� � - O 'T '7 7 <br />ielephone Number <br />- � � — % �.._ <br />Dafe � . � � � ; _ <br />S %� � Y. _�.r. _9 ��L:%. <br />Fee <br />DEPT. APPRGVALS <br />p> / <br />Engineers --'�s��'i/1--:;2�f' '3���?�71- <br />Water �-�-- T� 3- Z'3 - 7�-" <br />Slreet <br />Communitofions ' f� .� - ZL -7 Z-- [1C�'TL� <br />Traffic �K� � - 7_2 - 7 z- <br />Planning �N'S 3-21- 7 Z- <br />CaU L�i;:i ��_� ��_; i;. �.L �: �.. <br />2d No�rs b^tore <br />construcbon is �' ' :; <br />