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t <br /> PUBLIC WORKS DEPIMTMENT <br /> 16775 South Howland, Suite 1 l N2 327 <br /> Lathrop, California 95330 v / 0070 �t32-- <br /> (209) 858-5592 IRE D E C V E D <br /> Fax 858-5259 <br /> ENCROACHMENT PERMIT DEC 10 2004 <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES <br /> TO: Name Mathew Battin Staff Sc ientist Date Issued j — I g - CD--1 <br /> 3017 Kilgore Road, Ste. 100 <br /> Address Rancho Cordova, Ca. 95670 ContractorSECOR INTERNATIONAL INCORPORATED <br /> Phone 916-861-0400 ext 276 Phone SAME <br /> (Permittee) <br /> Date work to begin T i37 License No. <br /> PERMISSION IS HEREBY GRANTED TO: To INSTALL ONE GEOPROBE & ONE MONITORING WELL, <br /> AS PER ATTACHED DRAWING. APPLICANT MUST NOTIFY KEVIN CONNELL, CITY INSPECTOR AT <br /> (209)520-6914, 48 HOURS PRIOR TO CONSTRUCTION. n� q <br /> DSP- i <br /> (Attach 1 set of plans or sketches) <br /> to do work in City right of way as shown on attached application and subject to all the <br /> terms, conditions and restrictions written below or printed as general or special provisions <br /> on any part of this form, and/or attached hereto. <br /> Your attention is directed to the general provisions printed on the back of this form. This <br /> permit is to be strictly construed and no work, other than that specifically mentioned above, <br /> is hereby authorized. <br /> This permit shall be void unless the work herein contemplated shall have been completed <br /> by De_c_eS , , 18'-2.Qff. <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement <br /> to all the conditions and requirements of this permit. <br /> Signaatuurrree of Perminttee� — Director of Public Works <br /> By: <br /> Permittee or Authorized Agent <br /> PERMIT IS NOT VALID UNLESS EXECUTED BY DIRECTOR OF P LIC WORKS OR <br /> HIS AGENT. <br /> WHITE-Permittee YELLOW-Accounting PINK-File <br />