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l�t�°-p <br /> CITY OF 1tbCKtON <br /> DEPARtMW OP PUBLIC WORKS <br /> APPLICAtION POR ENCROACHMENt ON PUBLIC RIGHt-OP-WAY <br /> N° 61066 <br /> Aeobaatt's Nari <br /> APPROM! 151111 OF PUBLIC WORKS <br /> toeoeen e1 OroMbsed Wer4,ett.%t�a�'� <br /> _of C,e <br /> 0r,W/Cbntrdeibr Ad&$d ey <br /> hfimoled Storfbrq be11 A�`e—!� C64ellert Nis 9'—.30"9 Permit teplmflon bofe <br /> I for Wel hereby apply ter do ehtrodchmenf permit to carry out the following work: rtS(4 /� y <br /> a 4Lck t <br /> CL7�v <br /> TM oiSdve hhrhed dpbiltonl hedby requerls petrnlrrton to- WWI FEE ....... .........................____....... l <br /> Addlflbndi Foolnoe Poo, .. .... .... . <br /> $ewer top bepoelt .. ......... _.................. <br /> TOtAL DEPOSIT .......__............. s <br /> Building Permit No. <br /> Improvement Plan No. <br /> §upplemental Conditions: <br /> ' 6G l'-EJTY/G/�Y TCI ..�a.T or <br /> .�u.tar 4�r Olt �yr <br /> Show skikh ebovi of refer Ib drowmit)ubmloq, !/ 1/ <br /> IMPORTANT, Applicant hereby agrees to comply with all prevision/ of this permit as well as all applicable City ordinances, <br /> resolutions, Sfandardi and ipedfkdNohs turrenfly in effect, and to pay to City its actual cost for removal and proper replace- <br /> ment of any item which dod not meet above teinjuirementi. Failure fb comply Will be cause for revocation of permit. Appli- <br /> cant agree! fe IndAMIktIfy and h6ld fht! City hdnnlesl egalnsf any diid oil IdeSei, torts, or damages resulting from injury to <br /> persons, death of perlbn 6r ddmage 16 ptapetfy occurring df fhe sik of 6r ill el teSUlf of work to be performed under this <br /> Permit, Cerfillcefe at inlutance will be presented by applied f up6n r! uest. <br /> peed Go"til Proylden1 en nota Bide of hill plrtnil bili Ild requlretnAnl el nellflcellone end Inepeen6ne. <br /> Pernill EngineerllA/peelor (4 q <br /> 944-8480 �QQ�� � /0 <br /> 944.8388 Signedi � Monet) 6 4- <br /> ht— ".Inee 2rd-4I1e Mrd—Flnonco atF--Uhilty/Street <br />