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<br /> APPL(CATION FOR RIGHT-OF-WAY USE PERMIT
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<br /> CITY ENGINL6H5 �
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<br /> HerebV applies for permission to ___ _r�r, s t r..a i.f' �: 2�' A 5+2f, O�w c n _����L�,2C�---
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<br /> I�RIVCWAY I.1_[.-'�N � Tlu;iuiJunq�ned u�vm.i hri�.',r� aqn'r�� l��hUIJ Gnd
<br /> NO SCat.E savc harmless thc Gty of flvr�rtt Iro�:� any and all
<br /> �� � � - L�5 ' claims lor dama9es that may arise because of initalln�
<br /> �,,' �, _' '^i iWn and maintcnantc of thc imp�ovement hereto
<br /> �_�--- - - - - - --- - -�-.-1 appl�eti7or d further a9rees to remo�c same upun
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<br /> I 30"� i ,,,.3`'��, notice from hc City and to icplate�xifilic propcity
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<br /> j� Shyr�turc o( ApP�icant
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<br /> ICOP�' OF TI-IIS,Af'f�l.l;'..1i1(7;: i0 � � � � �� C�� 3 � -
<br /> I OE POSTED ON JOG,�'.�7t =� j� - —
<br /> CALt. ENGINEERINGDCPT. 25�J�88il1 ' �/� TelephoneNumlxr �
<br /> 24 HOURS BEFORG CONSTRUCTIO^J� �� Datr. �'
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<br /> CHECK LIST Fec . •
<br /> w,te�vaivc Dept. Approvals
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<br /> Curb a Gutter Enginccrs__. _ __.._. __ _ .__
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<br /> 1 i'.�.�;,. �� � , . �.,, . � ._ APPrnvcd by
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