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LCR PUBLIC WORKS DEPARTMENT <br /> ' �Ilantec� ' 1001 W Center Street <br /> ® y Manteca, CA 95337 N2 4452 <br /> 10 ENCROACHMENT PERMIT <br /> ' Contractor: M 1 T G H L LL D R I L L I N G <br /> Prosect Name: FORMER R 1 N o S TAS!O N <br /> License No: C~5 b116 11 — <br /> Project Location: C IS Y s T R E C I E AS T 0 F <br /> ' Address: 106118 MtLAt10 WAY 101 RAYLOW AVENUE <br /> RANCHO CORDOVA CA 95610 Date Issued: <br /> ' <br /> Phone:–(916) 631 -3583 <br /> _ <br /> ® License Verified Q 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 /> PERMISSION IS HEREBY GRANTED TO INSTALL ONE G-ROUNDWAM-1Z MONITORINGWELL <br /> WELL WILL Rt CONSTRVCTED WITH 2- INC14 VIAMETLR PVC, IN AN 'F-INCH <br /> DIAMETER SOIL BORING-, THE WELL I4tAD WILL I3E PROTECTED WITH AN <br /> ?-INCH DlAt-JETER , FLVSH - KOVNF AND TlkkPFIC RACED STREET BOX, 'rht <br /> WELL ( NSTALLAT[ON SHOULD 13E COMPLETED IN APPAOX (MATELY 6 HOMS. <br /> i <br /> (Attach Two Sets of Plans or Sketches, If Applicable) <br /> EASE 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 /> - —� - _ /_5_ , 20QL <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 /> Permittee or Authorized Agent <br /> PERMIT NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR HIS AGENT <br /> 0' WORK COMPLETED <br /> ' Forms\Encroach doc (Rev 08/95) Date By <br /> i <br />