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,� o�-bb�,- ��.4 , ;�� <br /> The Undcrsigned �' �"�� � ' � "`'' ' � Da1e Approved <br /> . . <br /> Hereby applies for permission to ��� `-'� � �' ' � <br /> � <br /> 1 � � ' � <br /> At the following lomtion r �� ' � �i�� � f'�•�1-� - � <br /> ...._..-.�,.,._..: --�-�,,....,.-:.a..,,.. .�... �.. _..,...�...�.�... <br /> SKETCH — -- —_-- <br /> (Work to be donel <br /> � Ll��� % ?� .� `✓�' <br /> 1� '"'`'�' cv�/G. D,2i 1- '� <br /> � �, � ' <br /> � i ,, , <br /> � ! <br /> �' � <br /> � 3 <br /> � � <br /> v � <br /> o - - <br /> � � <br /> The undersigned owner hereby agrees to hold ond save harmless fhe Cify oF Variance Required <br /> EvereR irom ony ond all daims io: damages that moy arise because of the Yes..._ . .� <br /> ..............___... <br /> insfallafion and maintenance of the improvement hereto applied ior and ..7 � <br /> furfher o rees to remove same u on nolice irom the Cil and fo re lace all No.__ ....._..._...._._ � � . <br /> 9 P Y P t�:,;�:�' <br /> public property damaged thereby. r ` + �':�.��+ � <br /> r�%� <br /> `�• � � �:r.� �' .�� _� ;.'. <br /> M �Signalure ol Applicnnf� <br /> �. ,. � <br /> , ' .' /. %• /, ,'' . . <br /> aad,e,: : <br /> ,� 5 , . > > ;y <br /> . Telephone Number <br /> �� ---_� (,C'� `/ � Dafe . <br /> Ci 1-�1� \�if�14�a-/ <br /> Inspxlor's hfnafure /— $ '� ' <br /> � �` , , i„ <br /> � Fe1 /., <br /> ,cl �,,,.�, <br /> �. , <br /> Dale � ' L -� O:.� e� <br /> / _ <br /> DEPi. APPROVALS <br /> .'� r v .I , <br /> Remarks Engineea � �- � �"- i � �-'i- <br /> Water �� � <br /> Strecl <br /> ;1�,rYl.�G,.. <br /> Comm����r'n�,����� ,-1 — <br /> Tmffic „/ ��`' <br /> � Planning <br /> v � , <br /> . <br />