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RESIDENT SIGNATURES Page of <br />We have been informed, agree to, and request that the Board of Public Works of the City of <br />South Ber <br />4 ai4horize a block party in the area described as: ,p <br />r from A��w to <br />Street Name Cross Street Cross Street <br />Date of Event o7•_ <br />1. C. <br />Signature Signature <br />Name �1� ��f 1�d 2 fi�-G " Name <br />Address 1 % �� N r �/UIl� 'tfi Address 4 ` <br />Phone No. �7�%��s %� {,�D�� Phone No. SY4 - N, ~ cy X) <br />Date �` �' 6 Zl Date <br />Signature 9r\, Inc - Signature - <br />Name (,-. 1,4- Q MAIS� Name i f eL c'e — <br />Address I -) D (V vj e rob t-. � , c. k Address i M 0 <br />Phone No. {o S `7 a t( Phone No. <br />Date G Date (? <br />I ONNYIYYMIIIIYMYIIIIInIn111pYY1\ <br />3. 8. <br />Signature '� Signature <br />Name Name -� <br />Address n Address42Y <br />Phone No. 76 cif <br />Date �J <br />4. .� 9. <br />Signature <br />Name" �.A � <br />Address. 7da�lcIr� <br />Phone No. <br />Date <br />, <br />5. Signature <br />Name w <br />Address <br />Phone No. ?j `I k -A C p %� <br />Date <br />I IIIIYY <br />Phone No. <br />Date <br />Signature <br />Name <br />I <br />Address c I <br />Phone NX6a` <br />Date <br />10. <br />Signature.; L <br />Name vow` -- <br />Address 1 .. ✓i]i� c_� S4-. <br />Phone No. <br />Date �•���� <br />Updated 912017 <br />5 <br />