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STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.7(98) Permit No, <br /> 1004-STK-0047 <br /> DISVC,ofRte1PM <br /> In compliance with (Check one): <br /> 10-SJ-580-13.38113.69 <br /> ® Your application of JANUARY 15,2004 <br /> Dale <br /> ❑ <br /> Utility Notice No. of JANUARY 22, 2004 <br /> Fee Paid Deposit <br /> ❑ Aoresment No. of $ $246 <br /> Performance Bond Amount 0) Payment Bond Amount <br /> ❑ R/W Contract No. of $ $ <br /> Bond Company <br /> Bond Number(t) Bond Number(2) <br /> TO: <br /> ARCO <br /> C/O STATUS ENVIRONMENTAL, INC. <br /> 3330 CAMERON PARK DRIVE, SUITE 550 <br /> CAMERON PARK, CA 95682 <br /> ATTN: SCOTT BITTINGER <br /> TEL. : (530) 576 2062 <br /> I <br /> , PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Install roadwork sign on the 1-580 northbound off-ramps and southbound off-ramp to <br /> warn public traffic of the road work ahead. <br /> In accordance with General Provision No. 6, TWO WORKING DAYS PRIOR to the start <br /> of this work, Permittee shall notify the State Representative MARCEL DE LA CRUZ, <br /> P.O. Box 2048 Stockton, CA 95201, (209) 948-3656. All work under this permit must <br /> meet with the approval of the State Representative. <br /> The following attachments are also included as part of this permit Inaddi-m to fee,the permittee will be billed <br /> (Check applicable): actual costs for. <br /> ® Yes No General Provisions ❑ Yes ® No Review <br /> ❑ .Yes ® No Utility Maintenance Provisions ❑ Yes ® No inspection <br /> ® Yes ❑ No Special Provisions T ® Yes ❑ No Field Work <br /> Yes ® No A Cal-OSHA permit required prior to beginning work: <br /> # (If any Caltrans effort expended) <br /> Yes ® No The information in the envirom mental documentation has been reviewed and is Considered prior to approval of this <br /> permit. <br /> This permit is void unless the work is completed before JULY 31, 2004. <br /> This permit is to be strety construed and no other work other than specifically Mentioned is hereby authorized. <br /> No pri work shall be commenced until all other necessa ermits and environmental clearances have been obtained. <br /> t-Permittee APPROVED: <br /> I-File <br /> 3—M-DE LA CRUZ <br /> JULIE DUNNING, Acting District Director <br /> ]jLE <br /> // <br /> Pete - MEN , Di trictPermit Ineer j/?-? �� <br /> ens e„aan <br /> 90/b0 39Vd dI_lVD ON sniv6is S0099L90ES LE:9S 1700L/Z0/L0 <br />