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Contractor: <br />License No: <br />Address: <br />A9uci Sieict <br />1-1 0 -00C) <br />2o B 12 L —Pol-y4 d o <br />' <br />PUBLIC WORKS DEPARTMENT <br />1001 W. Center Street <br />Manteca, CA 95337 N9 4021 <br />ENCROACHMENT PERMIT <br />, CA O L152-(0 <br />Project Name: Fto4 0 c 5 {----nr <br />Project Location: 2c)q-2_ `Jct.( ky-c— <br />c/1-1--e--rei <br />Date Issued: 7-O 0 <br />Phone: qzs—gzo <br /> License Verified 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 />-rvive)110-1 14-Leoi tl <br />S7)() <br />o-f- r P c'ff <br />Ov-A11. <br />(Attach Two Sets of Plans or Sketches, If Applicable) <br />PLEASE READ THIS PERMIT CAREFULLY. KEEP IT AT THE WORK SITE. To arrange for an <br />inspection, 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 1 30 ,20O3 . <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 />-662t By: <br />Permittee or Authorized Agent <br />PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT. <br />WORK COMPLETED: <br />Forms\Encroach.doc (Rev. 08/95) Date: By: <br />By: <br />SQ.\ 00 2 c• 6L1 3