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r _ I <br /> .J.r NO.3� <br /> ta' CITY OF RIPON-ENGINEERING DEPARTMENT , i <br /> 259 North Wilma Avenue,Ripon,CA 95366 F <br /> 2091599-2108-Fax: 209/599-2685 <br /> ti <br /> ENCROACHMENT PERMIT <br /> I <br /> ij <br /> Date Submitted: 2 <br /> Applicant s Name: _ <br /> . � 7 ( -<!(J /11.n: rr/. _ - CoutractOr:�. � �i9': �`;` Jirr� t 7r'J(vg <br /> r 7 7 t Lar- �� }„ /� J; x7 khone: <br /> Address• <br /> Contact Name: <br /> J <br /> - - er: <br /> Phone: License Numb <br /> i, <br /> t pursuant to Chapter 12.12 of the City of Ripon Municipal Code and all the terms,conditions,and restrictions <br /> written below,or printed: general or special provisions on any part of this fmm,'and/or attached hereto. <br /> PLEASE READ TffiS PERMIT CAREFULLY AND KEEP.IT AT THE WORK STTE: <br /> - npN(RTPTION OF PROJECT: 1 Provide a full description of work to be done at aff locations. <br /> :-4uach two(2)sets ofplans or sketches Yappl,icable- <br /> PERWSSIONISMEBYGLiNTED TO 2t lf <br /> ! <br /> l af..; (r.J7./ I ( /Aj 'ca .., !.. c• l: ct r.. l J;, of!/ A 4r <br /> -1.J' Ph:',1 <br /> ( <br /> i <br /> TO ARRANGE FOR AN INSPEMON,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: _' <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/Permittee : City Engineer(or authorized Agent) ' <br /> AppLcaaul-emattee or Authorized Agent -------/ �� �/`V(., ('rJ•1 J h :- <br /> .. nate 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 /> constmed and no work,other than that specifically mentioned above,is hereby authorized. . <br /> i <br /> PERMIT NOT VALID UNLESS EXECUTED BY MY.ENGINEER OR HIS AGENT <br /> y s <br /> WORK COMPLETED. " <br /> BY: <br /> vma.rua : YNlor-0vacEtw <br /> PING-Appilnlrt _ <br /> I <br /> L <br />