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�� �y i • <br />ai' �; <br />At the foPowing locatio��� C i %� �/ i<-- _ <br />` ---- --_ ____._._,,,�____�_. ___._.. _ .. _. .._ <br />SKETCH <br />IWork to be donel <br />i ;5 -- <br />�_, ` . ` _ , �' <br />----- - �- - -- <br />�,-� . <br />y�, � '�-`���' <br />C G r�-G� IC�CZ,���,� p, <br />� f <br />[?� ( 1 !r i7 . <br />The undenigned owner hereby agrees :o hold and savc harmless thc City ��f <br />Evcretl from any ond ol. doims (or damages ihat may arise because of ihe <br />installolion and mointenonce of Ihe improvement hereto applied (or ond <br />furiher agrees lo remove same upon notice :rom Ihe Gty ond In replace oll <br />public property danaged Ihereby. <br />i <br />Cin-c'L" �, � �� li .l <br />u <br />���r�� <br />r , <br />� <br />��, ,� , �� <br />_ � d- ! Y iC'i :. . _� <br />Inspe:for's Signolurc �� � <br />/ <br />i <br />�_ � .' - .�" � <br />Dale <br />C: % <br />C'- <br />Voriance ReGuired <br />Yes . <br />_..._ ..__... <br />No.. ...._ . <br />Signalure o( Applicanf <br />ndd,�ss <br />ielephone Number <br />Dafe <br />� <br />Fce <br />) DEPi. APPROVALS <br />Engineert "�a%��� �� l f�-�" - <br />Water ��� i • <br />Slrecf _ � <br />Communications_�:-..l �-''�,�1��- <br />Traffic T- <br />Planning _ <br />