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rage 1 of Z ENCROACHMENT PERMIT C o +��y �e Py PERMIT NO. <br /> CITY OF TRACY J 1 PERMIT GRANTED : <br /> PROJECT COST <br /> PERMIT FEE : f10 4 ,vorE A Eco. -)) <br /> APPLICATION IS HEREBY MADE FOR A PERMIT TO ENCROACH-OH&' OLG�r/ DE IF v <br /> D�TN cn1 S/ft�i 3 cF j <br /> .17- C)lz N �/V_CLE <br /> FOR THE PURPOSE OF I/J57,4Qrnn GzvQ <br /> jN0 w�;�n �,, ,v„�p„A) WEL_,�_S <br /> NAME OF APPLICANT <br /> Adoare6L,_d /1, #DRESS SDO .SOnsomeS} Sr.J CA 94/lI PHONE : 6L5) qjj- G7pU <br /> APPROVED BY �QI.�6/ 1//� JJ�/ FOREMAN: <br /> �LL' D/G69iA)( (800) 64z - 2.444- COMPLETION DATE : <br /> TPre Permittee shall notify the City Engineer (836-4420) Twenty-Four Hours prior to start of work <br /> pertaining hereto. /'� <br /> (0. a „ well covey ShAII be set -1��jj u)A L-A 'awn SUiigc.0 (Saol ill cin, - CITY INSPECTOR ' S REPORT <br /> t 80�( Gdge � ha vo�� ) where wellS 1175114 Iles( , Al de„ &,,-L. <br /> 1 . Temporary paving moist be placed after backfillYES NO NLA <br /> . <br /> 2 . Plan required YES NO BACKFILL PAVING_ <br /> 3 . Profile required Subw+i4- we-0 I09S ) YES X NO INITIALS <br /> 4 . Performance Bond required YES NO HOURS <br /> 5 . Notify Police & Fire Departments iF blockln9 s{reaEs YES NO DATE <br /> 6 . Open Trench Maximum LENGTH NIA WIDTH NIA CONCRETE <br /> 7 . Approximate Starting Date Apelf, i 1 -1 ASPHALT <br /> 8 . Approximate Completion Date Sec No, 9 low SIDEWALK <br /> 9 . This Permit void 90 days from issue date unless otherwise <br /> stated in Special Provisions SIZE OF CUT <br /> 10 . Pavement Replacement (Sawcut) SQ. FT . INCHES <br /> 16 Paving to be done by CITY -# CONTRACTOR PAVED O . <br /> Minimum cover street 36" sidewalk 30" BILL No . <br /> 13 . Contractors must display name and phone number at work site - CHARGES BACKFILL <br /> Preferably on barricades. PAVING <br /> 14 . The cost of emergency work required to restored unsatisfactory PAVING INSP . <br /> construction that becomes a hazard will be charged to the <br /> Permittee. DESCRIBE STREET SECTION BELOW <br /> 15 . Replace full concrete sidewalk squares, as required, by sawcutting <br /> along score marks. <br /> 16 . All work to be done perCity of Tracy Standards . <br /> 17 . Special Provisions See below AN DOTE ° = I7 vrfher inS e�ton S re vro� }� c c��� c4nb II be <br /> 18 . Compaction Tests Required on Ba kfilled Trenches (Contact City Engineering De artment ) <br /> 9 . Agreement Required. YES NO. Iled . <br /> f <br /> 016 ✓/IOr71 rprin / e o�nc�fnf—y we.l11 sh4ll be alone ul accerdance wifh G{, of Tracy and San Joa v.� Local - fP Y <br /> // �lcall� D sfncf or <br /> a -table reg vire",e.,�J. WeU C�/.Rsu.c�.c_B. as <br /> eaVorul wig, w C.L ..1 . a S �'all ' be Placed a� uPProximy+ply s x ( 6 ) InLhGJ below a devalk <br />