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PUBLIC WORKS DEPA�MENT -We N2 499 <br /> 16775 South Howland, Suite 1 <br /> Lathrop, California 95330 .rC{}D15R*CxD-6q?1q <br /> (209) 858-5592 <br /> Fax 858-5259 <br /> ENCROACHMENT PERMIT <br /> TO: Name Thomas Parker Date Issued Jul 21, 2003 <br /> 3017 Kilgore Road, Suite 100 <br /> Address Rancho Cordova, CA 95670 Contractor Secor International <br /> Phone 916-861-0400, Ext. 232 Phone 916-861-0400, Ext. 233 <br /> (Permittee) <br /> Date work to begin July 21, 2003 License No. <br /> PERMISSION IS HEREBY GRANTED TO: <br /> To drill and install one groundwater monitering well. Applicant must conform to attached <br /> supplemental condition. Applicant must notify inspector 48 hours prior to driling well. <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 co templated shall have been completed <br /> by _ VJ V �— � <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 Permittee Directo of Pu is orks <br /> By: '-� - By: <br /> Permittee 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 />