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CITY OF RIPON - ENGINEERING DEPARTMENT NO. 3 3 2 *1 <br /> 259 North Wilma Avenue,Ripon,CA 95366 <br /> 209/599-2108—Fax: 209/599-2685 <br /> ENCROACHMENT PERMIT <br /> Applicant's Name: Date Submitted: <br /> Contractor: I <br /> Address: �3 -it.1 A, ic, Phone: i aF -t/ <br /> Contact Name: <br /> Phone: I License Number: <br /> Pursuant to Chapter 12.12 of the City of Ripon Municipal Code and all the terms,conditions, and restrictions <br /> written below or printed as general or special provisions on any part of this form,and/or attached hereto. <br /> PLEASE READ THIS PERMIT CAREFULLY AND KEEP IT AT THE WORK SITE. <br /> DESCRIPTION OF PROJECT. 1.Provide afull description of work to be done at all locations. <br /> PERMISSION IS HEREBY GRANTED TO 2.Attach two(2)sets of plans or sketches, if applicable. <br /> t <br /> f <br /> j <br /> TO ARRANGE FOR AN INSPECTION, PHONE 209/599-2108 AT LEAST 48 HOURS PRIOR TO CONSTRUCTION. <br /> This permit shall be void unless the work herein described is completed by: 4 <br /> j Date <br /> Accepting this permit or starting work herein described,shall constitute acceptance and agreement to all the <br /> conditions and requirements of this permit. <br /> Signature of Applicant/Permittie City Engineer(or.authorized Agent) <br /> 0 <br /> Applicant/Perinfftee or Authorized Agent Date Issued <br /> NOTE: Your attention is directed to the general 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 /> PERMIT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT <br /> WORK COMPLETED: BY: <br /> Whlte-Flle Yellow-inspector Pink-Applicant <br /> R—� <br />