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PUBLIC WORKS DEIN.-iRTMENT Na 224 <br /> 16775 South Howland, Suite 1 <br /> Lathrop, California 95330 <br /> (209) 858-5592 <br /> Fax 858-5259 <br /> ENCROACHMENT PERMIT <br /> TO: Name TOSCO (CIRCLE K) #1205 Date Issued 4/9/01 <br /> Address 16470 CAMBRIDGE ST Contractor GETTLER-RYAN <br /> LATHROP CA 95330 <br /> Phone 925-551-7555 Phone 916-779-2910 <br /> (Permittee) <br /> Date work to begin QUARTERLY License No. 220793 <br /> PERMISSION IS HEREBY GRANTED TO: <br /> ANNUAL ENCROACHMENT PERMIT <br /> (Attach 1 set of plans or sketches) <br /> to do work in City right of way as shown on attached application and subject to all the <br /> terms, conditions and restrictions written below or printed as general or special provisions <br /> on any part of this form, and/or attached hereto. <br /> Your attention is directed to the general provisions printed on the back of this form. This <br /> permit is to be strictly construed and no work, other than that specifically mentioned above, <br /> is hereby authorized. <br /> This permit shall be void unless the work herein contemplated shall have been completed <br /> by , 19 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement <br /> to all the conditions and requirements of this permit. <br /> Signature of Permittee Director of Public Works <br /> By: �— By: <br /> Permitt e or/Kuthorized Agent <br /> PERMIT IS NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR <br /> HIS AGENT. <br /> WHITE-Permittee YELLOW-Accounting PINK-File <br />