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The Undersigned � � <br />Hereby opplies for permission to ' <br />At the following location ^ � ^� % � _ <br />SKETCH <br />IWork to be done) <br />I"- bp, <br />Datc Approved <br />,'' �_. j�l;. <br />The undersigned owner hereby agrees to hold and save harmless Ihe City o( <br />Evemtt from an� and all claims for damages thol may arise because of Ihe <br />insfallalion and mainlenancc of Ihc improvement liereto applied (or and <br />further agrees b remove same vpon nolice from fh� Cily and lo replace all <br />public property damaged Ihereby. <br />, _.._-- .:r, - ��t;� i�3tl <br />� ( _ `� <br />; - <br />„ <br />•,. � ...._� �:=i' <br />; ....... .. . : .�..' -. . --^-�,r <br />� '�` ' -._7.. � �"r•_J <br />� 1 ...�.. ��v_.... MY • <br />Inspeclor's Signalure <br />_�Lr� �. %�E� t�.�� 6 /d-7i <br />Dale <br />Remarks <br />r—�— —_� _ __. ._ . _..---------' I <br />IPROVIDE FOR <br />f'R(;�'ER DRAINAGE <br />� 1 <br />^ + I <br />�`) \ <br />J .��� ,v <br />�� ����� 'n <br />�°�"� �h,� � ��r <br />� <br />Cflll Frn:mecrir; li.: , 7:;�� oFllb <br />2�i !lours b;fnre <br />�onstruction is started. <br />-- - � <br />uI� <br />� %<I-� PL. <br />Varionce Required <br />Yes..._. ____..__...... <br />No..... __....._......... <br />�i);�:! • �\ �� <br />,'� . , '�� % ��( <br />$ignalure o( Applicanl <br />�� �NI�I�A'I.,�1.� <br />Address ` <br />93.i- 374r <br />Telephone Num6er <br />Dafe � <br />5 �� _r -I>0 I.I 5� �2 ��j 1 <br />Fee <br />DEPT. APPRQVA4S <br />. � <br />Engineers �� ��G�% <br />Waler � �: � /��c�Q � <br />Strect � ---------- <br />Communimfionc.� � ��J�:.. ,.,/.%.. ��.. , <br />Traffic �='.i✓ -Cr=!%1' G �i /7i <br />Planning _ �L�f"� <br />,. �,.�-�- <br />_ ' i�TH �.'JATER <br />h� :,:1. �Oii \'JAi'ER LWE <br />LC'Cl�ii:ii�!; pFt=ORE F�CA�'ATION <br />