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_ ,, ------ - --- <br /> „�--752,''�`" ("��-�. .� r��;`� . . J�;��.. , . _/_� . <br /> At the following location , 1 <br /> � ;� � � /� � � �i--- <br /> SKE�CH ' ` �q ` �� �— —� <br /> (Work to be donel `=� ���-7O � <br /> U /D'� '�c:�J.1'". :.'V✓. .Cf :"� <br /> .: s� <br /> r j � <br /> /% �9oi�' W �,-.��:: .- <br /> s,�,a.r ; ��,ci ..-. � �: <br /> s^• � v id <br /> � � � ; <br /> � 16 <br /> o �� i 0. t ; L Rv�� <br /> ��s / � �I ! � � �_% e . <br /> � ; <br /> 3� 35 � — - <br /> � <br /> \ �ati�sr. o�•� '�. dd� <br /> a'O —_ `��' <br /> 4p <br /> � � . "�. <br /> '� � <br /> _ � ; �� � � � <br /> �� ��n. <br /> ��? �j <br /> I <br /> The undersigned o�mer hereby agrecs lo hold and savc harmless thc City of Variantc Required <br /> EvereR !rom any and all claims for damages that may arisc bemvsc of the Yes..._ .__.. _.. ......... <br /> installalion and maiNenancc of thc improvement hcrclo applied for and No.___...._..._...... .. <br /> (urthrr agrees to remove same upon notice from ihe City and lo replace all , <br /> public property damaged thereby. ���}'�-�? C� I Fv�J(:i ti =P�s '['�'' <br /> ._...___.. . .. . . , <br /> . . ..— ------ <br /> ; JFiWL-�.�. � ;,ltCi�lON � ..- : <br /> ' ' <br /> ... . .. .. _-__.._ . -'_ <br /> (=�c "., L=) .e ,��, . _- — � ( ' �; , � �j"�✓'�i., <br /> . � '� � '-� r'0'•? .-- .. .. Signaturc o( ApplimN � <br /> ; n <br /> ; ' ' � -' "'�. _ .'_ ;:'��! ;� �� ��, — .C-Addre;sn `' ( `� ' ' - , <br /> ' i ' ', <br /> .. . ._.. .. ... �. .:`.1 �:� . t• <br /> ._. �,,. i ' - -' <br /> - <br /> _' -- -�--- � . ....�..__. , � — <br /> ,.._ .. __. � .__..,._..., : ��f � - f� �� <br /> . ' It.""'. �f y! ��'r.�1 �. � -- - • <br /> ' 1 <br /> ,_,__L_ __ + ielephonc Number <br /> ' k SE�i <br /> // i 994 <br /> r._...__ �:t��- �.,,:.- �.. � --• <br /> _ _ ..__�1__ , <br /> ..- . _ � Dale <br /> O Q� ^ <br /> Inspedor's Signalure ���jp/�p s / �~� <br /> rii:j..�•�l ��a" '. ^ Fee <br /> 9� �O ' li`i.'il:t <br /> �.T-��,y�c,��'� 'I � f; /� - �/� r z.. <br /> Dafe l <br /> ��_ yi <br /> I� DEPT. APP�VALS <br /> �"�'�. <br /> Engineerr'-S�rf'_k'ru/ ���/d <br /> Remarks � � � ,�,_ r <br /> Walcr � . :.L�"i��/-,C,. <br /> Streel <br /> � • '-_ <br /> Communicalions - <br /> Traffic <br /> Planni�a �= ''� <br /> ' NO'TY� <br /> ��i i r�:I� 11�I i i� '�;�r1Y�R ' <br /> '�R LINE �� <br /> - '`'� `�'cavnrro,v <br />