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PUBLIC WORKS DEPARTMENT <br /> 16775 South Howland, Suite 1 N2 252 <br /> Lathrop, California 95330 ��{$• stao3$�Zfi <br /> (209) 858-5592 <br /> Fax 858-5259 <br /> ENCROACHMENT PERMIT <br /> TO: Name Brive Hendrirk Pr je r + t:L ate Issued a_ 5- O�z <br /> 3017 Kilgore Rd., Ste 100 <br /> Address Rancho Cordova, CA 95670 Contractor secor International Incorporated <br /> Phone (916) 861-0400 Phone (916) 861-0400 <br /> (Permittee) <br /> Date work to begin License No. <br /> PERMISSION IS HEREBY GRANTED TO: Install two geoprobe soil boring <br /> @ Toro Lane & Mingo Way as per attached plans. <br /> *MOST notify Kevin Connell, City Inspector @ (209) 520-6914, <br /> TWO days prior to construction for inspection. <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 19 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement <br /> to all the conditions and requirements of this permit. <br /> Signature of Permit Direct of Public Works <br /> By: By: <br /> Pe ttee or Authorized Agent <br /> PERMIT IS NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR <br /> HIS AGENT. <br /> WHITE-Permittee YELLOW-Accounting PINK-File <br />