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PUBLIC WORKS DEPARTMENT <br /> 16775 South Howland, Suite 1. A 1 y- <br /> Lathrop, California 95330 <br /> 209 858-5592 <br /> Fax 858-5259 <br /> ENCROACHMENT PERMIT <br /> Steve Carter <br /> TO Name Stratus Environmental Inc. Date Issued <br /> 3330 Cameron Park Drive, Ste 550 <br /> Address Cameron Park, CA 95682 Contractor tl_ v'ec <br /> e <br /> Phone _(530) 6.76-6004 _ Phone 3—6 3LrZ <br /> (Permittf-e) _ <br /> Date work to begin v /o, ow License No. G `� 0 <br /> PERMISSION IS HEREBY GRANTED TO- <br /> To perform soil borning as per attached plans. <br /> (Attach 1 set of plans or sketches) <br /> 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 Permittee Direct 7,11t. <br /> 1'of P W <br /> 6Cr"—'� <br /> By: /� ✓ By: <br /> Permit ee dr Authorized Agent f <br /> PERMIT IS NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR <br /> ITIS AGENT. <br /> WHITE-Permittee YELLOW-Accounting PINK-File <br />