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<br /> fn:� pe;'r'nit i:': +ssuc�d pursupant. to all ptovi$ions; of City of Tracy Municipal Godr?. This pormit 15 granted upon the
<br /> r_ M'•;Yprc�ss canditlon that the- permittashall be responsible for all cls irr,s ane. liabilities ansinSl ou:of work performed
<br /> ur+der the perrvt or ari tlnc.j out of permittec'S failure to perform UtN oblig;atiuns with rr2�vFt'c�.u► 1 hr,ld h:�13il�ar srthe
<br /> T'h� pNrrriltle� �hiall, and by ACcr:pt�+ICt, Ot UIP pw_rmil agrees to, dr,fend, indrsiru�ih�, a t „ry e r�,wi Gtr to
<br /> it-.,it-., ofricors and ernploygties, from and ;�r];:tiinst any �lrld SII srlil;• Glaims of al tions Urr,uc 17t by p' .:
<br /> pr any budily injw irs, disF a::r` of illnts5 or dare+?►gr I.ra pr1'rVjns -rrid/or propr_rty sustainod or arising ir,
<br /> the corl:;truca.inn r,f the work pe:rfgtrtleci under the (rMi,mit or in consequence or permittce's failure to perforin the
<br /> cblica7tions with resorts' Ic) st'-OPt (11--t li:nanctu
<br /> v ions of thi! permit.
<br /> prrmrttee agree•a,tu .albide Vy the w ro iY
<br /> PERM I"1TTFF. � SIt,NATURE
<br /> c.
<br /> phis to exr:a�:�nun, t.,oritraclor roust contact the following to have below-ground facilibi S Inr at0d (48 hour: prior to
<br /> work).
<br /> UNUCRGR0t.lN0 SERVICE ALLA"r
<br /> Toll Free; (800)227-21500
<br /> Royd Service Center
<br /> (209) B31-4420
<br /> Note: You are notlned that Section cadn of the Labor Code requirr;%,the issuance of a permit by the Divi,ion of
<br /> Inc!urtriol aalfcty of the Stag of California prior to qie Con:.tructinfl of any trr^nch or exc:1vatlon which is five feet or
<br /> deeper and into which a person i:, required to descent_ Czcavation in city 3tree�t areas without an excavation
<br /> pr:rrmil mcay be Punishable by a fine_
<br /> permittee agre;r�K ttiat they hare-by 1r_r.,6+.pt Complrrq; rA,ponslbility For coordination with, rceporttng to, ;,rid complying
<br /> with the diroctlon of, any and all boards or districts, including but not limltod to, San Joaquin County Local Health
<br /> District and California Regional Water QuIllity Control Board, or any other regulatory agfoncy having jurladir_tion or
<br /> authority over soil or ground watc3r rontaminaticin such aS that currently found at the sib- of this work, including the
<br /> K,rr_3hrv:atlorl of the he-alth and safety of persons working neof or in ony trench or exr^-jv.yti0() car on the_ surf. of
<br /> the cion;truction prnjRct, or any person~ p.-assing by or observing, or any persons living in the vicinity Of the
<br /> construction project, for nny reason whatsor;ver that may adversely, or otherwise affect the health or safety, now
<br /> .and in the future:, of these persons or group of per:=s_
<br /> Furthermore, prrrnittae heret3y accepts complete responsibility for disposal Of arty petroleum etiffr•;cleci ;tolls, or
<br /> ground water, including reporting to and complying with they rnquiresrnent:; of any. or-oil, of tha stated, or any other,
<br /> re:guiatory z-igcncie . as dlseu:SO-zd lbc,vr,.,
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<br /> CINSPtWcTOR'S COMPLETION O
<br /> _ N REPRT PERMIT NUMBER -
<br /> ITY
<br /> DATE OF COMPLETION: concrete:: „T
<br /> Asphalt: _ Sidewalk: -�-.-w
<br /> sackful: Paving:
<br /> Size of Cut
<br /> Sq. ft. Inches Paved By-,
<br /> INSPECTOR SIGN OFF — --
<br /> 08/16/05 TUE 11:03 [T%/R% NO 66891
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