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--10V 00 '01 11:35 FROM: T-133 P-01/0 F-638 <br /> - Nov 00 f31 t15: 55p j;Lty of bumnkt-onPIJ- ermir:� [i? 1S3'7-B9U1 �_ 1 <br /> ��1 W' ICITY OF 6 NE <br /> PUBLIC WORKS DEP ENT N O V 0 9 2 0 0$ <br /> APPUGATION FOR ENCROACHMENT ON PUBLIC:IRIGl -OF- WAY <br /> r�pplCBntslllemr� o <br /> Daft-1r • ENVIRONMENT HEALTH <br /> (OwrrerlCangactoi} � APPROVED:BY'PMB Row' dT dT ` IECTon <br /> Addrastr--TF ? �Jn1F� fm'n—c" EMt PhIla tr .D rl ttr,4yp01to"aamm8lt'tev{ cmanaspgCltr(cowitlalls,awoB <br /> work mu�tCvnlaRfl td 1h6 pro�eet'gtapprovetl 3tsxrrt Water PgIItfllars <br /> �v rL Scene zip Fhevention Plan or ft Glty of awden asmm mbf FOltli►mn <br /> Lamm ofPrevention Maintat,snoo SUN*Lida.wNchever tS <br /> 3rr0ed .etc. 1�1t►� [•OI�YIrtf S, I-rrn�,f� applloable- <br /> Ar W cs} ^ ` s�}✓ <br /> ownar��'ama$C r�fCtdriBS A MAw 6e ,triey Dale <br /> r j. <br /> Et:tUt(egn11 b't8rtit7p Dills_ I C:ampJa7lan I I ! o Permit Explfoon Date � <br /> 1(or Ill hwepy elppfy for an EncroachMR to carry Wt tris olfting work- <br /> 27e, Y ' <br /> 1+a �It�+fs� sal+ s , AE i T��_ _ <br /> L <br /> Tris auavr n�mae�csK r�abr��Pa�nwabr,�- '� <br /> oar"lmrr mme............................ l� alr <br /> Addhanal Foefta Fee_.......,...S <br /> TrttrtCtl Fes_...�..........................S <br /> Post`It'"hrand fax tn2nami#al rnerna 7M +f atpeasa► <br /> �If S <br /> r r 4 r F� I Sewer Tap DepcmL................. <br /> COO. VQ- .5 <br /> � <br /> !r? c TOTAL.DEPOSIT.........S <br /> a.pr. �!►arw. <br /> wilding Permit Na. <br /> I mpinvement Plein No. <br /> Suppieme"Conrutimm. r d <br /> Its fOCo-FSC JY1 t ► <br /> lJe% .j <br /> ''de V ft ,1 1 S .<1l 'a� j+►� legit <br /> 1114PORTAt>iTe Appllealm hetl oy allFoes to"IV wlV,d prov gicw of thts Pam�h 1s+Bl ss all al+p1edle ally txdlnarlcea:rBaotl�tlans —` <br /> noSlamdentg and t:M4caJonu currelrsy in arrant,and to pay to"Clty ICs 805UNl eaut JQ rem and proper repimo mfani or&W Rer(11YNch does <br /> not rneatlt►e above regI:'uow,ww.Ffiftre to comply WIC be Gmm for rauocalian M pan lit.A;0k nt agmaa to inttmrdly and hold gm ft <br /> of or as <br /> mstatStlyf efpd trU Ins t.atals,or damn9ee main fig IMM inJartr to pe .daa#t of peraon arder�to iproparlyr aaetMhV at ltt8 site <br /> ot,or p r reac�It o!.work to b9 PQd0r Gd Wtftr Ihle pennit.A oereficata ortmauTw= ,all ba srkmm4d do 1ha City ISek N4mnmwr prior b,fsagarXM <br /> a(-tale perms. <br /> PERMITME 914ALL CALL t:k09)W-1-t66 FOR A C'Ot4 AOL NUMMI NO LM T 24 NQU9151,BUT NOT IN EXCESS OF 7E HiMRS, <br /> PRIOR TO THE WART OF tNDRIC,AND PRXM TOANY REQUIRED tNSPECTIoNS.AS IDENTIRED ON THE REVERSE SIDE OF TRIS <br /> P~.it iNO1tiC Oars NOT BeGIN VOMIN 72 HOURS 43F THE ISSL ANCE oFA tdI IAJIBEI�I.THF C.OtdTRIM NUkMA,WILL <br /> PFCOME INVALID ANpTME r enmiTTEE SMALL CALL FOR A NEW GONTROL ER.tFDR CAWTAt_INFPFIWFMI:NT PRO.lECT8 OR <br /> sjaDIY s"&4l'MV1;M0NM PJ AItA1TT E SHALE.OcINTACT THE ASsicIR D crY PnWEGT EN&INEW AT(2DO)937.8411 FOR <br /> SMC1F1U INSTALICTIONS PRIOR TO THE REGMlNIPM OF ANY WORK.) <br /> READ tiENERAL PROYMONS ON Ft8VE1R9(E SM OF TMS PJ=RWT BEFORE 2110 NIN& <br /> 1�s;�eey 2rxF�n�eiAlon 1PNth} 3 d�FNB IyeIID1Ny 4tfrFitfarcs{whlm} .� <br />