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- <br /> ��Manteeak4, PUBLIC WORKS DEPARTMENT <br /> ®® � 1001 W. Center Street N2 6873 <br /> �+�• Manteca, CA 95337 <br /> �i mnF <br /> f_ <br /> f <br /> ENCROACHMENT PERMIT <br /> i Contractor: �al Pe 1 _ jProject Name• IM Yoselwt'� <br /> License No: Project Location: I I6D Yt, Wt7' Ne, <br /> t <br /> Address: <br /> Date Issued: D <br /> Phone: <br /> License Verified Insurance Verified <br /> j 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 /> 11 PERMISSION IS HEREBY GRANTED TO: <br /> q <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 /> I } <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. I <br /> This pe it shall be void unless the work herein contemplated shall have been completed by <br /> 20P'Z_. f <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all the conditions <br /> i' and requirements of this permit. <br /> Signature of Permittee/Contractor Director,of Public Works <br /> 4 By: By: <br /> i <br /> } <br /> Permittee or Authorized Agent <br /> PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT. <br /> J WORK COMPLETED: <br /> i <br /> i Forms\Encroach.doc (Rev. 08/95) Date: By: <br /> i <br /> } J6JPgINtING(A�9&Nt6 <br /> t <br />