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wa <br /> ragN r d O 4~ <br /> ENCROACHMENT PERMIT Ccyn � <br /> CITY OF TRACY Lo} i PERMIT N0, <br /> 1 PERMIT GRANTED: - <br /> PROJECT COST <br /> tiPPLICATION IS HEREBY MADE FOR A PERMIT TO ENCROACH.�N_ PERMIT <br /> & fF( U�' NCR2 /DNS ,r r✓crE ecL w� <br /> �CDtA) -TF1 - ON Lb CAT Hew J <br /> -- ---- - PfFCK / Oitcibi. C//2CLE -- SIDE TF oN Stfc�T 3 c7,= 3 <br /> FOR THE PURPOSE OF /UST cctyT <br /> /U.J d� 2c;J,vO �il�i Z2 <br /> NAME OF APPLICANT <br /> /dLL mes QNr�S�tNS F <br /> 5 <br /> PPRpVED BY Moane 4DRE9s Sob Jans°me0 . <br /> PHONE: os <br /> -130-700$� a D1GCinf FOREMAN: <br /> The Permittee shall notify the C�t� Engineer 4 (836-Sg20) Twe <br /> COMPLETION DATE: <br /> Pertaining hereto. <br /> 1a. Ju Ba� Ba�z1) ver shall lie set '9wn my-Four Hours prior to <br /> start of work' <br /> u , <br /> emporary pavan nd vo,� where wells ),7 Iw" SHr}}1 e (yaj "�/� G01h- CITY INSPECTOR'S REPO <br /> Z•• Plan re g most be placed after backfill. ��`rk ---` RT <br /> required YES NO <br /> ,1: Profile required Submi4 wa(1 1035 ` BACKFILL <br /> 4 • Performance Bond required ) YES _� NO PAVING <br /> 5• Notify Police a Fire Departments ;F lockr� }r YES YES _YES � NO INITIALS <br /> 5- Open Trench Maximum b f s eels NO HOURS <br /> Z• Approximate Starting Date LENGTH" N` WIDTH P/A '�- NO DATE <br /> B Approximate Completion Date CONCRETE <br /> >. This Permit void 90 da —Sem NO' 9 law ASPHALT <br /> stated in S Ys from issue date unless otherwise SIDEWALK <br /> •�. Pavement Replacement <br /> Provisions <br /> 1 . Pav placement (Sawcut) SIZE OF CUT <br /> ing to be done by SQ-FT. <br /> Minimum cover street 36" sidewalk 30�ONTRACTOR PAVED By: INCHES <br /> BILL N0. <br /> Contractors must display name and <br /> Preferably on barricades. phone number at work site - CHARGES BACK-- FILL <br /> 6. The cost of emergency work required quired to restored unsatisfactory PAVING <br /> that becomes a hazard will PAVING INS—p:--- <br /> Permittee. be charged to the <br /> '.5. Replace full concrete DESCRIBE STREET SECTION BELOW <br /> along score marks•done sidewalk squares, as required, b <br /> G. All work to be Y sawcutting <br /> per City of Trac <br /> Special Provisions See below Y Standards. r <br /> Compaction Tests Re uired dTE = rr <br /> AW,�,Menc Re q on Backfilled Trenches r ur�Aer inS ec.fi <br /> qu3rad_ fired ��11 L <br /> y YES NO. (Contact Cit E °n �S Ye TtiG G '�c4�I will �e- <br /> h _ Y ngineering De artment) �P <br />