|
EVERETi, W��h.
<br />;:rpi::.�.. 'y
<br />. f ; %//�� �= i' � . � Y �%/
<br />- , !� n S v-'�. .y y, , � , _ . - - Da�c Approved _
<br />The Undersigned " ��
<br />- i: � ,
<br />Hereby applies for permission to �'✓ �fl � ! �' r '' �,+''f': "
<br />? , _ - . . ,� - ..J 1/ � - /.,'� - =�i - —
<br />At the following location % g `�'J ��/��M��'�l —
<br />SKETCH
<br />fWork to be done)
<br />.�- o..- -_. % �;�; ;
<br />- �`- —
<br />r�
<br />'+ ,_ � ,. �r
<br />�:. . r_ ._�
<br />The undersigned owner hereby agrces lo hold ond savc harmlrss Ihe City of
<br />[vcre0 from any and all daims for domages Ihot moy arise bemuse of the
<br />installation ond mainlenance of Ihc improvemenl herelo opplicd 1or and
<br />furlher agrees tn remove same upon notice irom Ihe Cily and la replace all
<br />public property damoged thcreby.
<br />_ ., _._. Wl`V�',:J,:i 5lCT10
<br />ii (NO SCALG)
<br />1 �M
<br />; �` ��`,��._.�__v' �.� a
<br />� � (p"'�"'_'_'
<br />Inspedor's Signalure
<br />,��Tr- � - /�/�CiG'�� 6/ %
<br />Dale
<br />� z PAR/:ulG i��->.-,._ ; ;�� �� .e�-�.ov�-��
<br />� � i�: i� :'G` ,3�9ticK oF
<br />( F,'�^�.r.�.-_ry Lieic.
<br />'.I ,. �/Ab'i T'�- � �,
<br />L�'DC• TO F� :�F' /r=
<br />,�:�ni �nsE-p �,�/'i� , :
<br />�z,,l:',nc '�i'-iln _...
<br />i
<br />iF).._,`4
<br />' f:OTE
<br />-CIt WITH WqT[R
<br />s i. FOR VlATFR LINE
<br />'_� �:hitnflS E�FfORF �XCAVATIOFJ
<br />� �!,� Y -�: > �// G�;
<br />Varioncc Required
<br />Yes
<br />No
<br />,
<br />Q
<br />� ��L1L�1 �_ �,..�
<br />" $igna�ure o( Applimnl
<br />jc o �s l�,c�>;�>r✓9�
<br />�'�� ' L 17^4� ��
<br />Address
<br />J ,. � ��9� �iyi
<br />�iC J�i �,,. � ,�� �r� nl���� <<�N�rt�c ielephone Number
<br />''�' � � �� �r' I'G'i � e C��a� �c � � I I��. `� �' �i � % �
<br />C/ Dafe
<br />` ��!'1�
<br />s ic, � i'���
<br />Fee
<br />GEPT. APPROVALS
<br />Enginecrs �'���..1��� `�/ �/f'� �/
<br />i
<br />"�' Wale�—•j, � _ .Ti ��-, /. f �� —
<br />Streel
<br />Communicafions � ',� "^' �
<br />TmHie F%* -Xe„ � � ,
<br />Planning �����
<br />PP,OVIDE fOR C4// �Sy_$i%g ,�,.�a.�
<br />inei:rin^ D.pt 159 fi; (!3 ' Fi�U��ER ORAINAGE in��s rtt .(�?r•r 1� Ce �•. �.-, Ce �,•�; ,, r`
<br />24 Hours before � , f, �; ,
<br />i.; < ,
<br />>�sfrnctinn !; sl�rted. � ' � '
<br />
|