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N1ECA� <br /> ." Manteca <br /> a, PERMIT NUMBER �r4 <br /> A <br /> ^ CITY OF MANTECA <br /> ENCROACHMENT PERMIT FORM <br /> Mailing Address: Phone (209)456-8586 <br /> Community Development Department <br /> 1001 W. Center St., Suite. C Email engpei-mits@ci.manteca.ca.us <br /> ci.manteca.ca.us <br /> Manteca,CA 95337 <br /> COMPLETE ITEMS 1 THORUGH 5 AND WRITE INITIALS ON PAGE 2 <br /> 1. PROJECT INFORMATION I 5. PERMITTEE'S SIGNATURE <br /> Project Natne PM 31415193 Please read this permit carefully. Keep at the work site.To arrange <br /> for an inspection,call(209)639-5964 or(209)923-0528 at least 48 <br /> APN/Tract## hours prior to construction. <br /> Project Location 435 N WALNUT AVE <br /> This permit is to be strictly construed and no work,other than that <br /> 2. PERMITTEE INFORMATION specifically mentioned in this permit,is hereby authorized. <br /> Name PG&E-Walther Tigerino _ <br /> 209-857-0181 X 1)2La�- �� 1/17/20 <br /> Phone PER6IITTEE'S SIGNA RE DATE <br /> E-mail wat8@pge.com <br /> License Number : A. FOR CITY USE ONLY <br /> Business Address: APPROVED(Yes/No) <br /> ✓ <br /> 3. SCOPE OF WORK License <br /> Insurance <br /> -tnstalLdeep-well-anosde_(see-skettch) Traffic Control Plan <br /> -- Monument Preservation <br /> — Moratorium <br /> 4. WORK DETAILS <br /> General Provisions/City Notes <br /> t <br /> Microsurfacing/Cape Seal Required? M <br /> Tentative Start Date 2/15/20 Fee Required$ M-I •W <br /> Tentative End Date 2/17/20 <br /> - ENGINEERING DEPT. <br /> Total Working days requested 2 hh <br /> ❑ TRENCH X <br /> Total Length(s)(ft): RECOMIV ENDED WR APPROVAL DATE <br /> WORIC COMPLETED <br /> Maximum Depth(s) (ft): <br /> ❑ CURB/GUTTER/SIDEWALK REPAIR X <br /> INSPECTOR DATE <br /> Total Repair Length(ft): Permit Not Valid Unless Executed by City Engineer of <br /> Community Development or his/her agent. <br /> NOTES <br /> Page 1 of 2 <br />