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, <br /> �"' ' '_ ' � j_ r-- <br /> _,�=_ f- ,'.�j� � YL:�� --i ' �_. _. ..., . <br /> r . , <br /> :_.C-.� <br /> v��T�: : <br /> �Ri' S/�L—�� %/i'�U � ��—�L � G'�J �,( �7 !D �C� C:[,�/�'�)�'«C,� �`� <br /> ,._._ <br /> �. (�C%��'/ `� / 1:^ 'r•`,Li"T, <br /> �{��_ \ � � <br /> (/ _/��C ��F �(i/. <br /> The undenigned owner hereby agrees to hoid and sa�e harmless the Cily o( Variance Required <br /> Evereff from any and all claims for damages that may arise becnuse o( the ;�� <br /> Yes._._. .__.___. ._... <br /> insfallclion and mointenance of the improvemenl hereto applied for and ,...� <br /> No. ___. ...__._....... <br /> further agrees to remove some upon notice from the Cily and lo replace all �� <br /> puhlic property domaged thereby. T•� <br /> -�:._� ;/ ('l��,� <br /> SignoFure of A�fplicanl <br /> ✓ �y��-�Qa�, ,:_ l�, �lz< t�! .��' <br /> � Address <br /> 4L- 9-�39 / <br /> ielephone Number <br /> �����Dafey� y'7 <br /> Inspeclor'i Signafure s <br /> Fee <br /> Dafe <br /> DEPT. APPROVALS <br /> Ramarks Engineers <br /> Water <br /> Street <br /> Communicalicn: <br /> Troffic <br /> Planning <br /> l ' <br /> �..� � ���4 ' <br /> � �, � <br /> � <br /> , i r <br />