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e� <br /> 1,0 • <br /> City OF 6tbCKtON <br /> MARtMENt OF PUBLIC WORKS <br /> APPLICAtION FOR ENCROACHMM ON PUBLIC RIGHt-OF-WAY <br /> �J N° 61066 <br /> bad <br /> AeelitanP(n.)�� <br /> l'r Nae�t �y��7e% ,/-. <br /> Addr11 /��Q -A L/Tclr^`/C <br /> e2—!S{''r55 <br /> y`j' f,� APPROVEb: billOF PUBLIC WORKS <br /> toentlen at Propoi/d Werk, <br /> o.,r./tenfrdel«AddrNe e AY>< b.io Is— <br /> Eftlm«1d Starling bale A—/�-9'L c6mplbi,*A bale Expirolion bole—/`-L <br /> I (or Wel hereby dplAy tot en eh0bachmeht petmif to tdrty out the following work: y—�-- <br /> F S 1- <br /> � V <br /> the eba�e ne�ad epbutonl hereby remdails paimlif3on to - POW PEE _..__ ...... ! <br /> Addltl"al Fee/o01 F611, ....... <br /> sewer top blpaill <br /> 101M WOW <br /> Building <br /> .._. _.. _.._... k—�.. -- <br /> Building Permit No. <br /> Improvement Plan No. <br /> §upplemental Cohdilions: <br /> tf�' Q.+ ice.. �4 kc Glo.yr.CiP—Y <br /> ct Ce 0--,?g UJOs'k j Cin <br /> 6� r-er7r��fi� �G SaT_ o� <br /> Straw ekefch a1»re or Nlar to drawin0 Wbmified <br /> IMPORTANT: Applicant hereby agrees fa comply with all provislons of fhls permif as will as all opplimble City ordinances, <br /> resolutions, standatds and speCiflcafions cutrenlly In elfecf, and to Pdy to City Ifs actual cost for removal and proper replace- <br /> ment o► any Item which does nal meef abbve Wfulrenlehis. Failure fb cbthply will 66 muse for revocation of permit. Appli- <br /> Ohd 1161d the dlid all ssofrom injury to <br /> cant agr6*11 fa tn lge oso <br /> persons, deIh at pee6r ddndge 16 papetfy6turingafNe life of Grasn resulf f wok 16bepertr ed under this <br /> permit. Cedltic % of inkurahce *11160 presehted by applicanf up6ri re uesf. <br /> peed osrNrRl Pt6vlel6ne eft rivaNe elde of Me petttill bel6te Ilg regiflrernlnl 61 nel fleellone end Inepeellone. <br /> PerntH EnglneeNlnepeel6r 1n' Q 14, , <br /> 94e-e266 0�Slvnad, Phen1 <br /> 644.6366 <br /> NI-9vminel Zrd—file ]rd—Finonce III�UIIIIIY/SfNal - <br />