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� —� �'— ?� <br />The Undertigned ,%��� J����% C�� ���= f�- ��Z''� Dale Approved <br />� - " �'1 � ;� J <br />Hereby applies for permission to ��'� � L����' �' ` � � � �'�' ��% •-'•���"` �, � ( `�� ` � � ��_ <br />At the following location ���' � �r' ''�� ���%��� �'�� �� G ��`� <br />SKETCH <br />IWork to be donel <br />The undersigned owner hereby agrees lo hold and save harmless Ihe Cily of <br />Evercll from any and all claims for damages that may arise becausc of Ihc <br />installalion and maintenance of the improvement hereto applied for and <br />turther agrees to remove same upon nolice (rom the City and lo replace all <br />public property damoged thereby. <br />DRIVEWAY SECTION <br />NO SCALE� <br />�--- �5' -�i <br />i I" LIP � <br />1�30'y 1 n • _�_30"_� <br />-t- <br />CF�(�LEL %-.5—%j <br />Inspeclor's $ignalure <br />�� <br />/�� <br />S/TF CNF—CK-rcD �--/5-73 <br />Dote <br />Remarks <br />Call f_n��inc�.�nn�t Dept. <br />2:i Hnnr hefiri <br />C.pil:lf:lC`:iup '15 � <br />2:;_� , ��3 <br />e. <br />FROVIDE rUR <br />PROPEk DRAINAGE. <br />D/Ir�/ <br />PA V � D) <br />OF PAVEMENT <br />Variance Required <br />Yes.. _. ... _...... <br />No..._ _..._._. <br />l � <br />// �LJrY�'1Y�i � C D ��., •'•'� �/-�:^_��-,.,L`- <br />/Signafure o( Applic <br />� , ,. <br />/G�G %//-��t l, �-�-�f <br />ddreis <br />�1 � � - � � �� �2��-c -�.r'•')l; <br />ielephone Number � <br />�l�}' )> <br />� //�L1t/ %, �G%7.� <br />—� Dofe f�� �', <br />S �l. J�C� ��'2''7�. <br />� <br />i' ��� <br />Fee) / . <br />,.� � ! 1•_ `•� t��il � ..; �. l f �• �� j S/�/ �' � <br />Engincers ' <br />i�c Waler <br />�:n <br />� Slreef '-'- 1 ( ' � .�., r-. �' :. <br />Communicatioi' � �1 �''„1:-r� <br />. � ,-�... <br />Traffic ' <br />Planning � <br />" t�lCT� <br />ciiECK wiTH vrnl�i� <br />D[f'T. F01� VJ:;7�!: UfdE <br />�ncnrioNs E+� � uwr Fxa <br />�: � PAV I ^l C-� � - - <br />0 <br />��� <br />- s�'z�o.�.. <br />�3 <br />