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CITY FJUPON- ENGINE YG DEPARTMENT NO. 22' <br /> 259 NgiSth Wilma Avenue,Ripon,0366 I r <br /> 2091599-2108—Fax: 2091599-2685 <br /> ENCROACHMENT PERMIT <br /> Applicant's Name: ,�j �` Date Submitted: g' <br /> (! Nt L �1L� T Contractor: IIA <br /> 03-e;, 5k <br /> Address: r -- Phone: .r <br /> _�ContactNa me: �� f -�T _. <br /> E <br /> Phone: Z License Nu�ber: I - ' 6 t/ <br /> Z/ <br /> I Pursuant to Chapter 12.12 of the City of Ripon Municipal Code and alt 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 PERART 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 HEREBY GRANTED TO 2.Attach two (2)sets of plans or sketches, if applicable. <br /> T r il46, , r-ter 31 0 <br /> iN <br /> CD c-e- <br /> UPS <br /> I SAN <br /> ROB <br /> a <br /> 210 444u.i <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 bye: 74 6,kti &.0 <br /> k t` If 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. i( <br />` Signature of Applicant/Permittee City Engineer (or authorized Agent) <br /> .r <br /> Applicant/Permittee or Authorized Agent Date Issued <br /> I <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 /> i� <br /> PERMIT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT <br /> II <br /> WORK COMPLETED: BY: <br /> White-File Yellow-Inspector `` Pink-Applicant <br /> i! Rev.B/oe f' <br />