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�1p4CA C' <br /> PUBLIC WORKS DEPARTMENT <br /> Manteca <br /> 1001 W Center Street 4021 <br /> Manteca, CA 95337 N2 <br /> ENCROACHMENT PERMIT <br /> Contractor:_ (Af& Sct ch(x Er-At-1 1 Project Name: o,c _ 5 �� <br /> License No: �f 0-7-00o Project Location: 2v�Z 1:-c <br /> Address: 2oe, y fit_ `PtnAh dd <br /> man-tlU— , CGS gY.52-�a Date Issued: 7-c2 0 <br /> Phone:_ Ciz s-g 2-0 -9 a4 <br /> R License Verified 0 Insurance Verified <br /> Pursuant to Section 12 of the City of Manteca Municipal Code and all the terms, conditions and restrictions <br /> written below or printed as general or special provisions on any part of this for, and/or attached hereto, <br /> PERMISSION IS HEREBY GRANTED TO <br /> t� � �r]?�` �'"� `YI..�" l✓1-��c.�.s. �}— w �Ivs-r r��7x -�-o �� <br /> h oY� <br /> (Attach Two Sets of Plans or Sketches, If Applicable) <br /> iPLEASE READ THIS PERMIT CAREFULLY KEEP IT AT THE WORK SITE To arrange for an <br /> nspection, phone 825-2309 or 239-8460, at least 48 hours prior to construction <br /> 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 /> This permit shall be void unless the work herein contemplated shall have been completed by <br /> 0 [ 30 , 2003 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all the conditions <br /> and requirements of this permit <br /> Signature of Permittee/Contractor Director of Public Works <br /> By By <br /> Permittee or Authorized Agent <br /> PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT <br /> WORK COMPLETED <br /> *orms\Encroach doc (Rev 08/95) Date By <br />