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y <br /> it <br /> �f <br /> CITY OF RIPON-ENGINEERING DEPARTMENT NO. 4 019 f <br /> 259 North Wilma Avenue Ripon,CA <br /> P 95366 <br /> 209/599-2108—rax: 209/599-2685 <br /> ENCROACHMENT "IT <br /> iP, <br /> Applicant's Name: '� ;124 JANUARY 2012 <br /> Date Submitted: <br /> Advanced GeoEnvironmental '•! <br /> a Contractor . Advanced GeoEnvironmental <br /> 837 Shaw Road <br /> Address: Phone: 2 0? 467 1006 <br /> Stockton, CA 95215 I` <br /> Contact Na e• 4illiam Little (969-4707) <br /> Phone: 209-467-1006 680227 <br /> License Number: ; <br /> L <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 f ll description of work to be dobe at all locations. <br /> PERAIISSIONISHEREDYGRANTEDTo 1.Attach two(2)sets ofphihs orsketches, if applicable. <br /> Monitoring well destruction by aver-drilling ;wells to total depth <br /> Backfilling of the well boring with neat cement and patch back to surface. <br /> Traffic control includes: lane closure southboundi� frontage road - signage <br /> two flagmen with traffic stoppage for lane clearance. <br />' Asphalt replacement two by two foot square with road grade spec asphalt: <br /> Estimated-Value ofRight-of-Way Work: i $ <br /> P&mjt F'ee: 30A Pian"Review: $. <br /> 3016 Site Inspection: S. i <br /> 1%GLS: qr' <br /> TOTAL FEE: S -CEJ . <br /> TO ARRANGE FOR AN INSPECTION,PHONE 209/599-2108 AT LEAST 48 HOURS PRIOR TO CONSTRUCTION. <br /> Y.: �. <br /> This permit shall be void unless the warp herein described is completed b ,t <br /> .� <br /> pate <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 />` SigtCity Engineer(or authorized Agent) <br /> Applicant/Permittee or Authorized Agent ! Date Issued <br /> 3 " <br /> NOTE: Your attention is directed to the general provisions printed on the back of'his form. This permit is to be strictly construed <br /> 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 /> i€ <br /> WORK COMPLETED: BY: <br /> Date <br /> �c <br />