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P,49LIC WORKS DEPl-wfMENT " NQ 441 <br /> 16775 South Howland, Suite 1 <br /> Lathrop, California 95330 ¢gyp 3/$95 <br /> (209) 858-5592 <br /> Fax 858-5259 AW /1/1 <br /> ENCROACHMENT PERMIT <br /> TO: Name Secnr Int rna inn^1 Tnr Date Issued 4—I6-0 <br /> Address 3017 Kilgore Rd. , #100 Contractor Fisch Env./Cascade Drilling <br /> Phone 916-861-0400/916-774-2910 Phone 916-774-2910 <br /> (Permittee) <br /> Date work to begin License No. Fisch 693965/cascade 717510 <br /> PERMISSION IS HEREBY GRANTED TO: <br /> Construct (3) each groundwater monitoring wells and (8) each geoprobe <br /> investigational borings as shown on the Secor figure 2 extended site <br /> map dated Feb. 1, 2002 subject to the attached conditions on Exhibit "A" <br /> dated April 16, 2002. <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 q- 1(0 M_ <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 a P is orks <br /> By: ���.,,,^y, By, <br /> Permittee or Authorized Agent <br /> HERMIT IS NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR <br /> HIS AGENT. <br /> WHITE-Permittee YELLOW-Accounting PINK-File <br />