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0 <br />The Undersigned C• �`�' �' ` �,`� �`rLE Y <br />J�V C ( <br />Hereby applies for permission ro �'O�r�� 7` <br />� r"' .� i' � �. ?,-) -•"' <br />G�.� fJ�����_..r'��� i.f_. <br />At the following location __ -`-�-5 '=�` � �' �-�'� ``� _�JE -- <br />SKETCH <br />(Work to be done) — <br />---_------- <br />� �. n�i� <br />/VE, <br />NEW <br />The undersigned ^wnen c�reby agrees lo hold and save harmless thc Cit� of <br />EvereM from any nnd all daims for damages thal muy arise because o( Ihe <br />installaiion and mointenance of the improvement hereio opplied for and <br />further agrees lo remove same upon nolice from the Cil� and to replace all <br />public properiy damaged fhereby. <br />DRIVEWAY SECTION <br />NO SCALE <br />�- 2P _ � <br />C <br />ri�•� 2C��— gp�� <br />Inspecror's Signafure <br />oore <br />_ - _. � <br />.�, �.:��II:�� ' I <br />;OP�R DRF.II�A�G � <br />_�,�- <br />1 :�"i�Il��'dS BFFORr [XCAVRl�i01V <br />� <br />Dale Approved <br />, <br />Variance Required <br />Yes.._ _.....__ .. ...... <br />Na_._.__....__..__ . <br />�, �,�%, �`Y} � �;w <br />Signafure of Applicanf <br />� r��� ��" 1`�IcXA�'ib� <br />`t�3- 3a�a _ <br />/7elepho e Number <br />If! �5'�7��� <br />Dafe <br />S �G �! ! (J /,, <br />Fee � <br />% !)�1 �. ���f ��� l , <br />DEPT. APPROVALS <br />Engineers i(_ ZY- ]2. <br />Water 1 ' � . (-� ., . <br />'� Street •, [. a . .. i_•. <br />. . . . - . . . _ ! - -- - <br />Communicalions � - - <br />TmHic � % /--� " � ' -'-`_. -- <br />Planning� - '�-- t � . -_ i -_ - /� : <br />:li,��l. i� �. ul'.: • <br />�rrnstruction is ttart?�� <br />1 <br />AKO rw, <br />