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10/04/2004 10:03 2095224"07 GEOLOGICAL TECHI—CS PAGE 03 <br /> U <br /> PUBLIC WORDS RTMENT �' c A11GK. a� J�S� 9zQOc;1001 W. Center Street <br /> Manteca, CA 95337N0 ,� <br /> ENCROACHMENT PER T <br /> Contractor-.\j oo a `\1' Project Narne: r <br /> License No: 2 I:> ri Project Location: �.. <br /> Address: ° L <br /> Date Issued: <br /> P <br /> one: \ '- l-1 <br /> 2 <br /> License Verified <br /> Insurance Verified <br /> Pursuant to Section 12 of the City of Manteca Municipal Code and all the terms, conditions and restrictions <br /> written below or printed as general or special provisions on any part of this for, and/or attached hereto, <br /> PERMISSION IS HEREBY GRANTED TO: <br /> (Attach Two Sets-of Plans or Sketches, If Applicable) <br /> PLEASE READ THIS PERMIT CAREFULLY_ KEEP IT AT THE WORK SITE. To arrange for an <br /> inspection, phone 825-2309 or 239-8460, at least 48 hours prior to construction_ <br /> Your attention is directed to the gener4,l provisions printed 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 /> This permit shall be void unless the work herein contemplated shall have been completed by <br /> 20QA_. <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all the conditions <br /> and requirements of this permit. <br /> Signature of Permittee/Contractor Director of Public Works <br /> By: By: <br /> Permittee or Authorized Agent <br /> PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT. <br /> WORK COMPLETED: <br /> FormslEncroach.doc (Rev. 08/95) Date: <br /> By: <br /> J4 J PRINTING(2041220.2114 <br />