Laserfiche WebLink
CITY OF RIPON - ENGINEEj,,,IG DEPARTMENT <br /> 259 North Wilma Avenue,Ripon,CA 95366 NO. <br /> 209/599-2108—Fax: 209/599-2685 <br /> ENCROACHMENT PERMIT <br /> 7' -7/ <br /> Applicant's Name: Date Submitted! � 7 <br /> f � <br /> _ Contractor: '� 1 � r. ,� <br /> Ne. <br /> Address:, f G ,� 1 �r Phone: -7 to <br /> r <br /> r <br /> r <br /> Contact Name: l k�h.t_ .( <br /> Phone: / f'�3�J License Number: <br /> Pursuant to Chapter 12.12 of the City of Ripon Municipal Code and all the terms, conditions, and restrictions <br /> written below or printed as general or special provisions on any part of this form, and/or attached hereto. <br /> PLEASE READ THIS PERMIT CAREFULLY AND KEEP IT AT THE WORK SITE. <br /> DESCRIPTION OF PROJECT: 1.Provide a full description of work to be done at all locations. <br /> PERMISSION IS HEREB Y GRANTED TO 2. Attach two(2)sets ofplans or sketches, if applicable. <br /> 04` � �.�(� � �- � 14' 41MM <br /> *. * 25ayz.ao-. .& #' R^ z''�' yycS ° , <br /> xs� ,,; #:, eacjsn * oat <br /> acv � o vuapl <br /> < a <br /> WZ <br /> TO ARRANGE FOR AN INSPECTION, PHONE 209/599-2108 AT LEAST 48 HOURS PRIOR TO CONSTRUCTION. <br /> This permit shall be void unless the work herein described is completed by: `J 1 ;k •' t_ � Y t� '- <br /> Date <br /> Accepting this permit or starting work herein described, shall constitute acceptance and agreement to all the <br /> conditions and requirements of this permit. <br /> Signature of AppIicant/Permittee City Engineer (or authorized Agent) <br /> Applicant(Permittee or Authorized Agent Date Issued <br /> NOTE: Your attention is directed to the general provisions printed on the back of this form. This permit is to be strictly <br /> construed and no work, other than that specifically mentioned above,is hereby authorized. <br /> PERMIT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT <br /> WORK COMPLETED: BY: <br /> White-File Yellow-Inspector Pink-Applicant <br /> Rev.N04 <br />