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Alaatae PERMIT NUMBER: O LO( <br /> CITY OF MANTECA <br /> ENCROACHMENT PERMIT FORM <br /> Mailing Address: Phone (209)456-8580 <br /> Community Development Department <br /> 1001 W. Center St., Suite. C Email engpermits@ci.manteca.ca.us <br /> Manteca, CA 95337 <br /> COMPLETE ITEMS 1 THORUGH 5 AND WRITE INITIALS ON PAGE 2 <br /> 1. PROJECT INFORMATION 5. PERMITTEE'S SIGNATURE <br /> SR99-SR120Interchan e <br /> Project Name 9 Please read this permit carefully. Keep at the work site.1'o arrange <br /> See attached maps for an inspection,call(209)639-5964 or(209)923-0528 at least 48 <br /> Address or APN p_ hours prior to construction. <br /> Project Location See attached maps <br /> This permit is to be strictly construed and no work, other than that <br /> 2. PERMITTEE INFORMATION specifically mentioned in this permit,is hereby authorized. <br /> Contractor Mame : Blackburn Consulting <br /> Phone (916)375-8706 --- X2--7-11— <br /> – ------ — -- PE TTEE'S SIGNATURE DATE <br /> E-mail danielc@blackbummnsulting.com <br /> License Number <br /> Business Address: 2491 Boatman Ave,West Sacramento,95691 APPROVED(Yes/No) <br /> License b"',3. SCOPE OF WORx <br /> Insurance t/ <br /> Drill F3 inh ag5 r—arla*np frortt-5 td$QJeeEdeeP— Traffic Control Plan <br /> for geotech soil samples. 1 boring per location <br /> shown on map. Holes will be 2"-6" in diameter. Monument Preservation <br /> Moratorium (� <br /> 4. WORK DETAILS <br /> General Provisions/City Motes <br /> 1 <br /> Microsurfacing/Cape Seal Required?ch 4 - <br /> Mar , 2.019 <br /> Tentative Start Date _ _ Fee Required$ �J�'� �' <br /> March 18 2099 <br /> Tentative End Date Ma— _..—_—. ENQ1?VEERtN(; D <br /> Total Working days requested 4 <br /> O TRENCH X <br /> Total Length(s)(R): <br /> RECOMMENDED FOR APPROVAL DATE <br /> Maximum DepthWORK COMPLETEDs}(ft): <br /> El CURB/GUTTERISIDEWALK REPAIR X <br /> INSPECTOR DATE <br /> Total Repair Length(ft): ,,.._ _- Permit Not Valid Unless Executed by the City Engineer or an <br /> authorized agent. <br /> 5-borings-will be aduanced-uvitb-asitill.xig_1_with-a-CP_T rig,and-2-with-hand_-auger_equipment.-B1, <br /> B2, and CPT 1 will be 80'deep.The rest will be 5-10'deep. <br /> n:.roachment Permit orm August 2018 <br /> Page I of 2 <br />