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,!���gN.1N•, c <br /> r' �y RUNTY OF SAN JOA UIP <br /> I•: �I DEPARTMENT OF PUBLICWORKS <br /> ZEt4f�fs,�otz83 <br /> • P.O.BOX 1810-1810 E. <br /> STOCKTON,C AVENUE Permit No:PS- <br /> CALIFORNIA <br /> IA 9 95201 1200180 <br /> (209)468-3000 Date Issued:01/25/2012 <br /> FAX#(209)468-9324 Exp.Date: 02/15/2012 <br /> Project No: PWp110005 <br /> Quad: NW <br /> To: THE SOURCE GROUP, INC. ENCROACHMENT PERMIT t3ECEIV <br /> 944 MCCOURTNEY RD. SUITE H �® <br /> GRASS VALLEY, CA 95949 AId <br /> Encroachment T e; 7 z0�z <br /> Bell Hole 1 ENVIRONIME <br /> DESTRUCTION OF A PERMIT-/SE Location: HEgLTN <br /> MONITORING WELL <br /> W/S OF STAR ST. 800'S/O ST.RT. 12 <br /> In compliance with your request of 01/25/2011,permission is hereby application and subject to all the terms,conditions and restrictions written below or rioted as general ors special Provisions on an <br /> this form, y granted to do work in County right-of-way as shown on attached <br /> See reverse side and attached sheet,if any. P <br /> g P P y part of <br /> Trench excavations for service connections will not be permitted within ten Feet(101)of pavement centerline unless otherwise approved by <br /> the Director. Surface of trench patches shall match in kind and be smooth and even with that of abutting surface. Special attention shall <br /> be given to depth of utilities through roadside area in anticipation of future drainage facilities,road profile and/or frontage development. <br /> All underground utility facilities are to be established and accurately dimensioned on sketches from surveyed centerline of road right of <br /> way,or from right of way(border)lines. <br /> Permittee shall call the Department of Public Works,Field Engineering Division <br /> forty-eight hours prior to beginning any work within the County right of way. All work performed under this permit shall conform <br /> to the rules and regulations pertaining to safety established by the California Division oIndustrial Safety and Calermit Inspections)at -OSHA 7421 at least <br /> Thejobsite shall be kept in a safe condition at all times by the daily removal of any excess dirt or debris which might be a hazard to either <br /> pedestrian or automobile traffic. All necessary traffic convenience and warning devices and personnel shall be provided,placed and <br /> maintained by and at the sole expense of the Permittee in accordance with the latest edition of the CALTRANS Manual of Traffic Control. <br /> After completion of the work permitted herein,all debris, lumber,barricades,or any ex <br /> Of completion(see attached post card)provided by Grantor. cess material shall be removed and the jobsite left <br /> in a neat workmanlike manner. Immediately following completion of construction permitted herein,Permittee shall fill out and mail notice <br /> special Comments: <br /> Traffic Control Per MUTCD <br /> **ACCESS TO ALL PROPERTIES SHALL BE MAINTAINED AT ALL TIMES.** <br /> FORMS: ISSIWW,R-29 <br /> Est. Permit Fee: $413.00 <br /> THOMAS M. GAU, Director <br /> WHITE -Pennitee Department of Public Works <br /> GOLDENROD -PWD Central File <br /> YELLOW -Field Inspection <br /> PINK -Permit Section B <br /> Permit Sectio —�_ <br />