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CITY OF RIPON-ENGINE", G DEPARTMENT V <br /> 259 North Wilma Avenue, - 3274 <br /> Ripon,CA 95366 NO- <br /> 209/599-2108-Fax: 209/599-2685 <br /> ENCROACHMENT PERMIT <br /> r �. <br /> Applicant's Name: Date Submitted: % Q - y- p a, <br /> �1 TC '/�SSa t i s his Tu,c Contractor: rc t o ; <br /> Address: J11 -7 L o n,t /�,/4$ Sv�.xt Phone: <br /> 9?s-3/3- s poo <br /> (',9 9 57-35-' <br /> Contact Name: NJ 4 r i GJg/e/r n <br /> Phone: P09- 5' 71-; 9a/ License Number: LS 7 - y 8S/ls <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 an <br /> y 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• <br /> 1.Provide a full description of work to be done at all locations. � <br /> PERMISSIONISHEREBYGR9NTED TO : 2.Attach two(2)sets ofplans or sketches, if applicable _ Q <br /> rlJanu tlrV Vtr '/�l Sei li0ri»4 -fo <br /> Qgero�trrinefr/v l b /Sa <u,A <br /> hir' , Collrt F G t✓ ! 4wp r ci d �r�✓/ {o tu/ �itrc <br /> 6ar;»q 4-v br 1eeA4d iA Fart'- I�OV»e) W <br /> Seesrd <br /> tl TO ARRANGE FOR AN INSPECTION,PHONE 209/599-2108 AT LEAST 48 HOURS PRIOR IQ_CONSTRUCTION <br /> This permit shall be void unless the work herein described is completed by:_ o -2t'• -,b oo <br /> Da <br /> Accepting this permit or starting work herein describedi <br /> ,shall constitute acteptante and a Bement to all the <br /> conditions and requirements of this permit. <br /> Signature of Applicant/Permittee City.Engineer(or authorized Agent) <br /> 4�t (d-zo•-o g <br /> Applicant/Pennittee 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 /> } <br /> PERMIT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT <br /> I <br /> u WORK COMPLETED; BY: <br /> WhaeFae Yellowdnspa r _ PInkAPPllcarrt <br /> jl �(` <br />