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PUBLIC WORKS DEPARTMENT N° 252 <br /> 16775 South Howland, Suite 1 <br /> Lathrop, California 95330 <br /> (209) 8S8-5592 <br /> Fax 858_5259 <br /> ENCROACHMENT PERMIT <br /> TO: Name _ trate Issued �- Q <br /> 3017 Kilgore Rd., Ste 100 <br /> Address Rancho Cordova, CA 95670 Contractor Secor International Incorporated <br /> Phone (916) 861-0400 _ Phone 1 861-0400 <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 /> *MUST notify Bevin Connell, city Inspector @ (209) 520-6914, 7't127'4— <br /> TWO <br /> 20-6914, 272TWO days prior to construction for inspection. <br /> (7,o r) e4ru <br /> Sy 2- <br /> 4b4b <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 Permi Direct of Public Works <br /> By: By: <br /> Pemiittee or Authorized Agent 1 -7 <br /> 16-YRMIT IS NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR <br /> HIS AGENT. <br /> WHITE-Permittee YELLOW-Accounting PINK-File <br />