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• <br /> CITY OF RIPON-ENGINEERING DEPARTMENT No. 3256 <br /> 259 North Wilma Avenue,Ripon,CA 95366 <br /> 209/599-2108—Fax: 209/599-2685 <br /> ENCROACHMENT PERMIT <br /> Applicant's Name: Date Submitted:/0 4� <br /> rn>4-r�s�r-fes <br /> -_IMF V60ieeF- t 96 IIS, /n/C, Contractor: Tf1� SoUnCjE (ltt!/? /W('. <br /> Address: 34g-i- ✓lA/ jfAIT Ror4b Phone: _NIZO x qZ-q <br /> Yt JkSAAlT /f/ CR 945613 Contact Name: /Y/A7T S'4/7'raAj <br /> Phone: AZY l 144-afMo x ,32-1 License Number: <br /> Pursuant to Chapter 12.12 of the City of Ripon Municipal Code and all the terms,conditions,and restrictions <br /> written below or printed as general or special provisions on any part of this form,and/or attached hereto. <br /> PLEASE READ THIS PERMIT CAREFULLY AND KEEP IT AT THE WORK SITE. <br /> DESCRIPTION OF PROJECT: /.Provide afulldescription ofwork--tobedone atall locations. <br /> PERMISSION IS HEREBY GRANTED TO 1.Attach two(1)sets of plats or sk-eicbes,if applicable. <br /> —Dr <br /> z k OIL QYfJUY1�4 J 4 IhflD"tt r� ryl'_ IC /814 -�tv� 0p <br /> ':.stzmated Value as Right-of-Way Work: S <br /> �9e In4E t C'9:. J 1O lli2n ?RtV ,,v-; <br /> ?OTAY, FEE- <br /> TO ARRANGE FOR AN INSPECTION, PHONE 209/599-2108 AT LEAST 48 1JOURS PRIOR TO ONSTRUCTI N. <br /> This permit shall be void unless the work herein described is completed by: 6 -d dy <br /> ate: <br /> Accepting this permit or starting work herein described,shall constitute acceptance and agreement to all the <br /> conditions and requirements of this permit. <br /> Signature Applicant/Permittee City Engi er(or oath ed Agent) <br /> 11) <br /> ��Atpicant/Pccmiecor Autho � i3 a� <br /> //%%�fJ//��,l�, <br /> 1 Agent Dat Issued <br /> NOTE: Your attention is directed to the general provisions printed on the back of this fort. This permit is to be strictly <br /> construed and no work,other than that specifically mentioned above,is hereby authorized. <br /> PERMIT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT <br /> WORK COMPLETED: BY: <br /> White-Ftle Yoliow-lmpcdar Pink-Appawnt <br /> aw.m. <br />