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10/21/96 � 1.4:l2� FAX 916 372 878.E _ <br /> CITY OF STDCI4Tt711f <br /> rte. REpAFtTMEIftt•!i 13F PU15 IC WORKS <br /> or <br /> APPUPATION FOR €NCPOACIIMENT OH Pt1I3iIG RIGH -OF11�'AY <br /> /M;V Dale <br /> Apvtie.ru'..Nsme _ CTOR <br /> lo."ricenoss�r7 it PM AFI'RCY1fEfl: pUSUC WORKSAIRIE' <br /> redress r <br /> Locown of PIOpaSLa ywork,ene. <br /> By <br /> pwn•rTG�lsxru.pder.ss �� .. r perrrar Expirai,Joel Dale <br /> vl - <br /> �pkrri5lit$lirlirlg t)iIP <br /> vC*t"PiLlion Wile <br /> out the foslawing work: <br /> I jor Wel hereby apply for an encroao:hmeltl pErmit to carry <br /> ------------ <br /> Tm.00•.c nart.ea evWrearx nenbr rap+nas D� <br /> mtisdrnw PERMITFEE............... .... S — <br /> Add104rx31 Fawnse Fte............. _ _— <br /> $o,rsr_►R DeOC7 is .. .. .......... r5.,_�_ <br /> . rt <br /> TCTAL DEPOSIT ......... S.._.. <br /> r ? Bviklifig Permit No. - _.. ----- <br /> EE <br /> tmprovemeni Plan No, _.. <br /> Supplemental Gondillons: <br /> rirlp�slcy:n xGew r rs'kl b dr+`+'+'C�v6fiSSle <br /> it as welt aS <br /> nces.re50IUIi0n& <br /> IMPORTAN-r Applicant hereby agrees to comply with allprovisions of this perm <br /> fort ten-oval alnd proper p ac rnern of any item wh ch <br /> standards and specifications Currently in ptlat'l,a Pay to <br /> does trot meet above requirements. Failure to comply will be cause for revocation of permit, p4ca t p teen or dam gclto and <br /> hold <br /> the City harrrrless apainst any and all losses.costs,or damages resulting from ir%jury is persons. <br /> desihD=uring at the site of or as a result­011* <br /> oi.work to be performed under this perrnil- A certificate of irrsurxnee shalt be subrnhied to the <br /> City Risk Manager prior to b+ginning conslrUctien. y <br /> pERMIT F-E SHALL CONTA 1JINIDERGROUND <br /> U'�1U SERVICE <br /> ALERT{7.60aeA42-24441 TWO WORKINGI DAYS 13EPORE 9GINNING. <br /> WORK FOR LOCATION OF UNDFRCR <br /> pERMITTIcE SHALL CALL(209}937-8411 24 HOURS PRION 70 START OF WORK FOR A CONTROL NUMB A AND TO 6CNELWI.E <br /> JNSPECTION. <br /> Read General Provisions an reverse side of this permit before signing — Note requireptent of notifications and inspections- <br /> Y, tynec. U �. <br /> � F' <br /> ild—Fri.xr IR� tY1 Sn►s <br /> I�r—r1111kt1� 7-Ck <br /> TOTAL P-02 <br />