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~~_~~~ _laa~ u~,: 56PM FROM ~. U. F'. F'. W. I . TO 91~5~~~''1-1~~2 F'. ,2 <br />:+-**+-* APPLICATION FOR ENCROACJEII~[ENT PERMIT **~++-* <br />CITY OF PLEASANTON <br />ENGINEERING SERVICES <br />(415) 847-^0041 <br />Date of Application Z-1-9 `~ <br />Date work to Begin t-g-9 9 <br />Date of Completion c. - - - 99 <br />Work Location : (/l~t,~, ur,~,p, ~C(v~ ~q~o ~Q.en, p,,/u~l- ~,,~y APPI # /~(~A <br />owner/Developer: G5T <J..a-Q.u~'»~- Phone: ~~5-8~2-s3s~ <br />Address: /'~~3 (~. ,~~,a,~c.a.C/L! C- ~' 9~~p <br />Contractor: GdLIF~G~i~ll,AI,,GDp~Ml1P/,L~~G~."T-bI•~S Phone: ~7b9-3 p- pS3 <br />Address : X335 ~'. ~o1,lJ~,Q~ ~T . Y1~.a• A , CS~L~) Qh~~ , ~ A' `~ 175 <br />Ca L i f . Contractor' s License # -13 5 7 7 ~ Type G7 ~ A Exp . Date S- 3 ! -~ ~ <br />workmans Comp. Carrier G (~lA Policy * NtCib7°1413-'7 Exp. Date 7 - I - 9 ~ <br />`ity of Pleasanton Business License # <br />Exp. Date <br />Description of proposed work: ~~,a.~' ~ n~ ~K..~,i1-~u l,w, Qi,,,,,. <br />~f? _ _ / ~yyl,LVrtl't ~- / CDyld~ccf XZ.U~.P~K : "~~ <br />3 copies of the plans for proposed work are to be attached to this application. <br />The undersigned hereby certifies that all work proposed herein will be completed <br />in a timely manner to the satisfaction of the City Engineer in accordance with <br />the provisions of Ordinance 341 and City Standards. <br />Hy : Date: ,Z -,Z - Title : ~~2~~~ (~~- <br />1 U <br />Application reviewed by: Date• <br />Observations/Special Conditions: _ <br />Plain check/field review: hrs. @ $ (1/2 hr. min.) <br />Ins~.pection Fee: (Select one method) <br />1) <br />2' ) <br />3! ) <br />Estimated hrs. @ $ (1/2 hr. min.) <br />Estimate of improvements <br />Trenching for Utilities <br />x 4~ <br />LF x 5. <br />Hond Amount required. <br />?ermit approved for issuances as noted above: <br />?v. <br />(efencrch} <br />TOTAL PERMIT FEE <br />Cash Sure <br />Date: <br />TOTAL P.O2 <br />02-01-99 15:03 TO: ~ FROM:510 484 8376 P02 <br />