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PUBLIC WORKS DEPARTMENT. No.'• 1120 <br /> 259 N. Wilma Avenue <br /> Ripon, California 95366 <br /> 209-599-2108 <br /> ENCROACHMENT PERMIT <br /> TO: Name (,lorenu A'Sa6'-JeS Date issued -2-11 <br /> DI <br /> Address 2-U)( Lark-0- St.) '�(P S23 Contractor i t)YQyIC� �SSOC.tQ YS <br /> C2_J CA g1�001 Phone <br /> Phone 530- ZIN- R4b3 License Number <br /> (Permittee) <br /> Pursuant to Chapter 12 . 12 of the City of Ripon Municipal Code and all the <br /> terms, conditions, and restrictions written below or printed as general or <br /> special provisions on any part of this form, and/or attached hereto, <br /> PERMISSION IS HEREBY GRANTED TO: 1 <br /> ��i �� U►1e �V�� ljvc'i .� � ��� Z�) �D �v �'� �-�'-oi,•> �1'-D tt�lJ SGc.��. <br /> �l <br /> •,�� 1�1S�Ll�( Gt 2- <br /> V <br /> (Attached two sets of plans or sketches if applicable) <br /> PLEASE READ THIS PERMIT CAREFULLY . KEEP IT AT THE WORK SITE . To arrange <br /> for an inspection, phone 599-2108 at least 48 hours prior to construction. <br /> Your attention is directed to the general provisions printed on the back of <br /> this form. This permit is to be strictly construed and no work, other than <br /> that specifically mentioned above, is hereby authorized. <br /> This permit shall be void } les the work herein contemplated shall have <br /> been completed by t-r 1_9� 200 1 <br /> Accepting this permit or starting work hereunder shall constitute <br /> acceptance and agreement to all the conditions and requirements of this <br /> permit . <br /> Signature of Permittee Director of Public Works <br /> By: By . <br /> 4AJ <br /> Permittee orfAuthorized Agent <br /> PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT . <br /> WORK COMPLETED : <br /> Date By: <br /> White-File Yellow-Inspector Pink-Applicant <br />