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SKETCH <br />IWork to be donel <br />�; ,.�s ; ,.� _ ,,� <br />ZA�, <br />isrini , <br />/. J �-' �'. <br />I - <br />� ---����¢. <br />! <br />� <br />� --- — ------ <br />I <br />� <br />F� — -- ---- <br />The ondersigned owner hereby agrees lo hold and savc harmless Ihe City of �� r'� �� <br />Ever�lt from any and all daims for damages fhal may arise ber.ouse of Ihe <br />installation and mainlenance of the improvement herzfo applied for and <br />further agrees to remove same upon notice irom the Ciry and lo replece all <br />public properry damaged thereby. <br />,���� <br />� f J � St /�� u ,.;;<. <br />- - j� <br />���70 �i-.-.�,{w� <br />.. .. , ;) �J �LNSN.=.,.. <br />� [1 <br />3'��D/7v !v-^���c��w. �'.�,f.,,r <br />t�0 .� `' ,� ) , !� <br />�� , , {,e. x.w.� �t.-ti.., �_> ��, , . <br />Inspedor's Signature <br />%.�G/-1� �-/2GiC Y�J�7�� G.'�. <br />Daie <br />,' �.i _ , �__ --,,��; <br />Variance Required <br />Yes.__ ._..._.___.._.. <br />No............__.__. _ _ <br />:=;ini� I_ �F�-r�NG �. S� C'.�, � ' <br />, . -, <br />�; �i� i..r= .__: ._� ;- _..- <br />Signalure of Applimnf , <br />�-/ 1 �,t .., <br />Address <br />:$��d' — . � � � <br />Telephone Number <br />.1/ J�% / �i' �' <br />/ Dafe <br />$ <br />Fce <br />DEPT. APPROVALS <br />Engineers” <br />/,�(�% Y o i %? i%G• <br />Walcr <br />Streef " � - --- - <br />Communicalions �� � �� <br />Traffic <br />Planninc� __ <br />