Laserfiche WebLink
CITY OF RIPON-ENGINEAG DEPARTMENT • NO. — (1 <br /> 259 North Wilma Avenue,Ripon,CA 95366 <br /> 209/599-2108—Fox: 209/599-2685 <br /> ENCROACHMENT PERMIT <br /> Applicant's Name: Date Submitted: Dij1/s f p 83 <br /> IIIATT $'U77Z)p -/ <br /> 7te- C'au2GC_a90l)P lWe Contractor: <br /> Address: 34!SL(' ✓IA)CCJT ROA7) Phone: 6a) 944-z$6"Ze a 32-9 <br /> `i LeAggwT 111, e1q 94123 Contact Name: _ &fi-rT rtl TcA) <br /> Phone: (qZ5) 9QQ –p2 SCP )C3?J�} — 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: 1. Provide a full description of work to be done at all locations. <br /> PERMISSION ISSqHEREBYGRAN�]TEDTO 2.IAttach two(2)sets ofplanso/rsketches, ifapplicable, <br /> , <br /> 1' ,\ lY� Q�t i9 >,n(Xc.JLt�� VY1 i T8,^tl�l P ��� 4lJL�'l� '��•� 1'-IJC�CI� <br /> 11Par �'>{� Gt7ell /a c ot,)n u,) a4�tc� � <br /> Estimated Valve of Right-of--Way Work: S <br /> Permit Feer 3%Plan Review: S <br /> 3%Site Inspection: S <br /> TOTAL FEE S <br /> TO ARRANGE FOR AN INSPECTION, PHONE 209/599-2108 AT LEAST 48 HOURS PRIOR TO CONSTRUCTION. <br /> This permit shall be void unless the work herein described is completed by: b bp og <br /> I te <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 of Applicant/Permittee City � !gineer{or autho .ed Agent) <br /> Appheant/Penrinee or Authorized Agent Date Issue <br /> NOTE: Your attention is directed to the general provisionsprinted on the back of this form. 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-PIle Yellow-Inspector Pink-Applicant <br /> nw.uw <br />