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Page 1 of 2 ENCROACHMENT PERMIT PERMIT NO. 8-7_ 0+9 <br /> CITY OF TRACY PERMIT GRANTED: 30-3-7 <br /> ' PROJECT COST <br /> PERMIT FEE: <br /> APPLICATION IS HEREBY MADE FOR A PERMIT TO ENCROACH ON THE NORr?4 SIDE OF leyevl�-� <br /> Al153 E• l/A J/-- ( F%r 645 Jr.- -r/OA/ ) _ <br /> am Vb. s !de cPr A]. "F wells <br /> FOR THE PURPOSE OF S LL4i.JUN QF RauArD WA71� /r10N1 rdR,,nj ult,L_L-S LO C4T/dAf,S -,qo uN ON SHc-Er ,3 of 31 <br /> 4 <br /> NAME OF APPLICANT 6r0y,nJ,,,,a + 1ec ,�o�oau � ADDRESSce nt#D C4n}[otZ C 94' PHONE : {4t5_ 6Zl - Z3$7 <br /> APPROVED BY FOREMAN: <br /> J Cr4L(_ U.S,,4 $E�2E <br /> DI <br /> IN (BDo) 64z- Z4¢ ¢ COMPLETION DATE: <br /> the Permittee shall notify the City Engineer (836-4420) Twenty-Four Hours prior <br /> pertaining hereto. P to start of work <br /> CITY INSPECTOR'S REPORT <br /> 1 . Temporary paving must be placed after backfill . YES NO �q BACKFILL <br /> 2 . Plan required YES X NO PAVING <br /> 3 . Profile required ( S(16/mr wtFLj_ "4s ) YES _x NO INITIALS <br /> 4 . Performance Bond required YES NO HOURS <br /> 5 . Notify Police & Fire Departments ?F' gLoc.r1NG STR.=-rs YES )C NO DATE �- <br /> 6. Open Trench Maximum LENGTH AILA WIDTH N CONCRETE y <br /> 7 . Approximate Starting Date ` l -) ASPHALT <br /> 8 . Approximate Completion Date fee No. 9 e w SIDEWALK'--- <br /> 9 . This Permit void 90 days from issue date unless otherwise <br /> stated in Special Provisions SIZE OF CUT <br /> 10. Pavement Replacement (Sawcut) SQ.FT. INCHES <br /> PAVED <br /> 1 . Paving to be done b _ <br /> Y CONTRACTOR i°. BILL No. <br /> 2 . Minimum cover street 36" sidewalk 30" <br /> 13 . Contractors must display name and phone number at work site - CHARGES BACKFILL` <br /> Preferably on barricades. 7 PAVING <br /> 14 . The cost of emergency work ,required to restored unsatisfactory PAVING INSP. <br /> construction that becomes a hazard will be charged to the t DESCRIBE STREET SECTION BELOW <br /> Permittee. , <br /> 15. Replace full concrete sidewalk squares, as required, by sawcutting <br /> .along score marks. <br /> 16. All work to be done per City of Tracy Standards. <br /> 17. Special Provisions 3ec be o�u 0dis, "A''= TF AdrAe_- r echo s re%Iv.red A-e 1 a f w►1! be b,11ec� . <br /> 18. Compaction Tests Required on Backfilled Trenches (Contact City Engineering Department) <br /> 19. Agreement Required. YES NO. <br /> Insklt',-600 Mgm, -ertmce. and 41-0&74�e abQ,�don,+,e�►f of^ »�ar►t�ar,�g w411s shall be cc�w,e apPi���nf <br /> 0nd tMPP�r� �J ex�ense <br /> GCGor dam, w1 G,�y Gf 7-r4ct 4nd Jan Jaa v,� Low l �eatl<l, n,sf�,�+ AW( or G.V. R.w. Q. C �. 4s <br /> 14 <br /> �ppr,Cable � req ua�Cmev►�. Us�1l� ca q <br /> 1 p a h4ll be laced 1 <br /> Co+rerG� wi Cl,r�s Al at apProx,matr,{� 6 �s►�� �»c.h�S bela.� S►c�c�a�k �r�ldc u�d <br /> Or SurraJ.�d.•► fvr 9 ,J,�.�c.,,`O.11 bay, Lu a,r� N 9'T ba 1�-�dcs�.rn !►d 5G+ �I+�s1� <br /> - — - —. _ __ 9 _. . ---�►GC. 4i aPP.t«u,1,le. <br />