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;•3 g1 io of L r:lY�:KUHI:riMk:IV i' Yr.ttP711' r�r�t•ti 1 iry . [�U 'U-1y <br /> CITY OF TRACY PERMIT GRANTED: <br /> PROJECT COST <br /> PERMIT FEE : <br /> :PLICATION IS HEREBY MADE FOR A PERMIT TO ENCROACH ON THE SIDE OF <br /> :ROM FEET OF <br /> DR THE PURPOSE OF <br /> AME OF APPLICANT ,ADDRESS PHONE : _ y/5_6 07 - F&6j�f) <br /> G►�C�iV'Gj' �,! <br /> ?PROVED BY FOREMAN: <br /> COMPLETION DATE : <br /> Permittee shall notify the City Engineer (836-4420) Twenty-Four Hours prior to start of work <br /> �� taining hereto. <br /> CITY INSPECTOR' S RE_PORT <br /> Temporary paving must be placed after backfill . YES10 BACKFILL PAVING <br /> Plan required YESNO <br /> Profile required YES NO INITIALS <br /> Performance Bond required YES NO HOURS <br /> Notify Police & Fire Departments YES NO DATE <br /> Open Trench Maximum LENGTH WIDTH CONCRETE _ <br /> Approximate Starting Date E2ASPHALT _ <br /> Approximate Completion Date _- -- L-1- fig, _ SIDEWALK <br /> This Permit void 90 days from issue date unless otherwise SIZE OF CUT <br /> stated in Special Provisions SQ. FT. INCHES <br /> 0 . Pavement Replacement (Sawcut) PAVED BY: _ <br /> 1 . Paving to be done by CITY CONTRACTOR BILL NO . _ <br /> 2 -)Minimum cover street 36" sidewalk 30" CHARGES BACKFILL <br /> Contractors must display name and phone number at work site - PAVING __ <br /> Preferable on barricades . <br /> 4 . The cost of emergency work required to restored unsatisfactory PAVING INSP <br /> construction that becomes a hazard will be charged to the DESCRIBE STREET SECTION BELOW <br /> Permittee. ----- - <br /> 5 . Replace full concrete sidewalk squares, as required, by sawcutting <br /> along score marks . <br /> 6 . All work to be done per City of Tracy Standards . <br /> 7 . Special Provisions r,-no <br /> S . Compaction Tests Required on Backfilled Trenches (Contact City Engineering Depar nt <br /> 9 . Agreement Required. YES NO. �, - <br />