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<br /> The undcrsigned owner hereby agreei Io hold and save hermless Ihe Cily of �/ Variancc Required
<br /> Everetl from any and all claims for damages thaf may arise because of ihe c - � C,• r;'�'� Yes
<br /> installalion and mainlenance of the improvemenl herelo applied for and ...1� �� � ���
<br /> I� furthe: agrees fo remove same upon nolice from fhe City and lo replace all N���������"�-� ��--� �������
<br /> 13' public properry damaged thereby. �~. ,
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<br /> I � � Signature of Applicanf
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<br /> SD _ 90 I / �S �• . _ .
<br /> • Address
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<br /> � � '��{��_' .`� S� Telephone Number
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<br /> Dafe . � .� -�-/;�'_.�.'.
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<br /> Inspeclor's 5ignafure Ipp 1,��l� �� $ � � . � Q �� :-'f`��
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<br /> �' Q y Fee �/7� ; i
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<br /> Dafe �(A(N : � 7f -�/ I[ '�L
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<br /> , � / DEPT. APPROVALS
<br /> /�OT�,' ��liiS�e:1) I�.ziv2.�/'.9Y _S"r�o:/c%l T'O 3� � � �! 7 � ��
<br /> � Remorks Engineer _
<br /> �f / �/ /� Water ' � !�-"i ��,
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<br /> Communicafioni 7�r ,!�,:r,:<r��, • � .-�f',�C�. -.
<br /> Traffic ��.�( , . -� - '�.
<br /> �/ J�f/���>/�r� r%r�—Ain�/nll 1-�,� L.S' Planning /�(� �—�), iY
<br /> T /�L� �/,cL D.✓ S=�OPF
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<br /> j Pr�OVIDE FOk 9/7.3
<br /> Q ���� � PftUPtR DRRINAGE !:-�1 Engineoring Dept. ;i�:; `;ill
<br /> CHECK WITH�ATER 7.4 HDUfS he(Ofe
<br /> DEPT. FOfi '� !_ItJE eonStfUCtiOr }tatled.
<br /> L;�Cnr�rr, !� ;, ,rEXCAVATION �- f�
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