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4 <br /> CITY OF RIPON-ENGINEET 'G DEPARTMENT NO. <br /> 259 North Wilma Avenue,Ripon,CA»_466 <br /> 209/599-2108—Fax: 209/599-2685 <br /> ENCROACHMENT PERMIT <br /> Applicant's Name: Date Submitted: <br /> Contractor: <br /> —C <br /> ( =Address: Phone: DIf <br /> 573 <br /> Contact Name: <br /> Phone:; "' e—o), 7 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 afull 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 /> -7- <br /> Qat <br /> ................................ <br /> g <br /> S. <br /> .V <br /> .0 <br /> ............ <br /> a. <br /> ....... ....... <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: 4, <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 Applicant/Pern p'tt <br /> ee City Engineer(or authkorized Agent) <br /> /f'!.,/ <br /> t0i 0 <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.6104 <br />