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tCA'` PUBLIC WO RKS DEPARTMENT <br /> .�- �. <br /> Manteca Y 1001 W Center Street N2 3782 <br /> r y Manteca, CA 95337 <br /> 4�ai anah <br /> ENCROACHMENT PERMIT <br /> n <br /> Contractor:_ Project Name: r�--•�'� � �� Jar <br /> License No: y�' "�'�� Project Location: <br /> Address: =-� �-•� CI p,,� <br /> Dpi,-tv, c X15 u Date Issued: '3 -fr - - - <br /> Phone: <br />' License Verified Insurance Verified <br /> Pursuant to Section 12 of the City of Manteca Municipal Code and ail the terms, conditions and restrictions <br />' written below or printed as general or special provisions on any pai t of this for, and/or attached hereto, <br /> PERMISSION IS HEREBY GRANTED TO <br /> (Attach Two Sets of Plans or Sketches, If Applicable) <br /> PLEASE READ THIS PERMIT CAREFULLY KEEP IT AT THE WORK SITE To arrange for an <br /> inspection, phone 825-2309 or 239-8460, at least 48 hours prior to construction <br /> 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 /> This permit shall be void unless the work herein contemplated shall have been completed by <br /> 49 2X-0~ <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all the conditions <br />' and requirements of this permit <br /> Signature of Permittee/Contractor Director of Public Works <br /> B <br /> By <br /> By <br /> Permittee or Auth ized Agent <br /> PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT <br /> WORK COMPLETED <br /> FormslEncioach doe (Rev 08/95) Date By <br />