HomeMy WebLinkAbout028-440-042SEP -15-03 01:42 PM
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EN CROAC 11 M E NT PFRNUT
County of Butte Department oCPublic Works
7 Count (;enter Drivc OrQvilic, CA 95965 Mond (530) 538-7681 Ext. 2016 Fax: (530) 53R-4356
Download Furr11g: www.huti watnty ncdvublicworks/forms.htMJ
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\ JTIF Y COUIv 1'Y 24 HOURS BEFORE WORK IS TO I2F._(X)r1F.
Phonc (530) 538-7631 1'--L2016
PCrtnh Ntnnber
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Disaiet
A.PPLIC MON
1 • TE, the undersianed. hereby apply ur -G9u!t;s OM111e ror nn ent•ruacmanent pe>;sttt)s: dts4ttrxu11ow1try markvniici ar ovu dte County roads
,And hien- ays, all i1) a+:oordance with County ordinanecs and genera) tau. (All idonnation except s' natum must be typed nr ICB'.b)X Dfill0d.)
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la. Company Nnru: --
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4, A5sess r s t orc..l Number. —
.. Locatio C o k be Doae A
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CL A kcft•s . iutut t , 7. Date. O
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CONTRACTOR'S INFORMATION
if Contractor's Nome
11. Pburr
11. Fns $• 3 O %SI �.3 �6
3 y. I:anuu�iur'e l.0 rnrs �umlwr
5. Cwificate of lanuvnev. : Yes ❑ No; ❑
14. Contn tlr s sIgnarurt:
A
Ida. nme . ierud:
TYPE OF WORK TO BE DONE
Curb; ❑ Gullt.•1; ❑ 5idcwulk: ❑
17 1)nvouay(I.x1'rypo)• IK 1Nher
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PF.R117iT GRANTED
w id, du: Low wyuca. at d aubji:N to all ulna, e,nnlit;Am (iml-Aing Ot-v ort page 2 of this per Con»1 and spttiol tondilioas,urittro glow,
i htcisberebvgnultrd.
11. L'onttrions
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d 't •rax C . m IMtir1m t wmkin d t riar.In ani,valum. 8lY •::7•�tln
2Q K' fill wnrk sfiall•confonp to inwinpanying; Detail X Plaits U SPccit:l Conditions a
216 w!e loved 2 l0 03 27. bxpntlon Ihic•Z /O G X23 5=T,
Ely-
imikc (:rump, Director of Public Works 13off./
a • Note: upermits are rated to any nun txT bcsides (%-3,0) 'l 'K-1`1141, tncy can oo uc.aycu up w -u ..—
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