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�L� i�. �� �� <br />The Undersigned_�. ��f� — r� •`- � Date Approved <br />Hereby applies for permission <br />At !ne following location�" -' � — = _ ;' r-'- '= -' <br />SKETCri <br />(Work to be done) . <br />� <br />.�. <br />;=; � '3° s � • <br />---._ --- <br />7he undersigned owner hereby agrees to hold and save harmless ti�e Ci1y of <br />Evereff {rom any and all ciaims for damages Ihat may arise beca�se of the <br />insfallation and maintenance o( the improvement herefo applied for and <br />further agrees to remove same upon notice from the Ci1y and to replace all <br />public properly damaged theieby. <br />✓_E�.P,,r: _sccrlaN <br />t�+n°- scncs) <br />L'D =: �q" <br />�"�!_�. � F� ___.. <br />. : � _ - <br />Inspecror's Signafure <br />� S Ji.E C�[= C':K/--/) `��ii�7i <br />Dafe <br />��. � <br />�'iJ'',`� <br />K�� � HA�� ('Erzni ! #3/S/ <br />A7T9cNFD TD 80E.'335r <br />kli �! L t�T�',� , <br />�•Ro <br />n <br />-J <br />� <br />J <br />)J <br />Variance Required <br />Ycs. _ _ _._........ _._..... <br />No. _ ................... _.... <br />��j'- n r; /_ <br />��-- :.�` (+�+ `���t-'�t. ...1 <br />Signature oF Applicant <br />��'� G ; � 3 S �- <br />Address <br />,5�1, - z- S 3 / r� <br />ielephone Number ' <br />- -�i <br />i/� ; <br />Dale <br />'� ,_� �:O �,�' �. <br />rmarKt <br />Engineers <br />l Water� <br />/ �/Y%/%� $Imel— <br />Gall Engineering Depi. 2,59;?ou3 <br />24 �iours 5efore <br />construcl;on is star,cd, <br />' NOiE <br />CHECi< WITH UdATER <br />pEPL (OR VJATER I tN[ <br />6.(1CATIONS BEFORE cXGAYAT!C1N <br />Planning _..,����� <br />PROVIDE FOR <br />PHOPER pRAINAGE <br />