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40 �L9.C) <br /> PUBLIC WORKS APTMENT "D s FZ.DO 3 p`t: <br /> Manteen w 11001 W.Center Street <br /> Manteca,CA 95337 N2 6027 <br /> E�IsNCROACHMENT PERMIT <br /> Contracto 'ltd : in - 12r'�Nptl,l�C6 Project Name: Nzt-I WA" WELL <br /> LicenseNo: Project Location: 4/7 S,Q/rtrearr- W S✓ <br /> Address: 21(43 Rte Lti, lit/t4kT� C -. 4 3� <br /> _5glrA2143- CA-. 153-20 Date Issued: 07/Z0yS— <br /> Phone:_Zo5 5-32 - 0361 <br /> of License Verified Insurance Verified <br /> Pursuant to Section 12 of the City of Manteca Municipal Code and all the terms, conditions and restrictions <br /> written below or printed as general or special provisions on any part of this for, and/or attached hereto, <br /> PERMISSIONISHEREBY GRANTED TO: <br /> Cb KJS 1721 (-L- VM-J )I-6v 4"tj WELL FOIL- W (Q C_F-: <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 contemplate5,slrall have been completed by <br /> OLy z 1 200S_. <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 /> By: By: <br /> Permit a or Auth OZ Agent <br /> PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT. <br /> WORK COMPLETED: <br /> Forms\Encroach.doc (Rev.08195) Date: By: <br /> I s J PRIMING WFJ2ID.]WI <br /> Tuesday,July 12, 2005.max <br />