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4NUXUAUHMENT PERMIT PERMIT NO. <br /> CITY OF TRACY PERMIT .GRANTED: <br /> PROJECT COST <br /> PERMIT FEE: <br /> r <br /> PLICATION IS HEREBY MADE FOR A PERMIT TO ENCROACH ON THE Y SIDE OF <br /> QOM FEET a6 }' OF <br /> )R THE PURPOSE OF (� .. S­ Lam, U� <br /> sME OF APPLICANT " ADDRESS S ALV �o�tcvV PHONE: 1//6- <br /> PROVED BY1 FOREMAN: <br /> COMPLETION DATE :' <br /> Permittee shall notify the City Engineer (836--4420) Twent�-Four Hours prior to start of work <br /> taining hereto. <br /> / CITY INSPECTOR 'S REPORT <br /> Temporary paving trust be placed after backfill . YES ✓ NO BACKFILL PAVING <br /> Plan required YES NO <br /> Profile required YES ✓_ NO INITIALS <br /> Performance Bond required YES NO HOURS <br /> Notify Police & Fire Departments _ YEStd0 -� DATE <br /> Open Trench Maximum LENGTH WIDTH CONCRETE <br /> Approximate Starting Date - ASPHALT <br /> Approximate Completion Date SIDEWALK <br /> This Permit void 90 days from issue date unless otherwise SIZE OF CUT <br /> stated in Special Provisions SQ .FT. INCHES <br /> Pavement Replacement (Sawcut) PAVED BY: <br /> Paving to be done by CITY CONTRACTOR BILL NO . <br /> Minimum cover street 36" sidewalk 30" CHARGES BACKFILL <br /> bContractors must display name and phone number at work site - PAVING <br /> Preferably on barricades. PAVING INSP.- <br /> The cost of emergency -work required to restored unsatisfactory <br /> construction that becomes a hazard will be charged to the DESCRIBE STREET SECTION BELOW <br /> Permittee. <br /> Replace full concrete sidewalk squares, as required, by sawcutting <br /> along score marks. <br /> All work to be done per City of Tracy Standards. <br /> Special Provisions <br /> Compaction Tests Required on Backfilled Trenches (Contact City Engineering Department) <br /> Agreement Required. "YES NO. <br />