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OCT 26 '98 07:46PM PARSONS ES P.4 <br /> 608 7 i <br /> CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Applicant's Name pct..t.5cnt_5 .. ,.r .� <br /> (Owner/Con iracior1l <br /> Address <br /> Locatlon of Proposed Work.etc .�� AZ5,krpe,6u - APPROVED: PUBLIC WORKS DIRECTOR <br /> Owner/Comraclor Address <br /> --- <br /> .... _. ------ -- --- .... ._ <br /> _ ... <br /> Estimated StarBy Date—__.,Staring pate _ 9 ��'�--^-Comptehon Oate .` �7 <br /> Permit Expiration(Dale <br /> I (or We) hereby apply for an en`croac�menl permit to carry out the following work : __ <br /> _ t, -7L, <br /> The above Pained applicant hereby requests permission in <br /> PERMIT FEE <br /> Ata "f Additional Footage Fee _.------ -_- <br /> � ( k-r4bL ~ AhlM r 0t—t V1 C4 Sewer Tap Deposit <br /> f I UJ l"[ J TOTAL DEPOSIT <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> Show sketch above or refer to drawing submitted <br /> IMPORTANT:Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances,resolutions, <br /> standards and specifications currently in effect,and to pay to City its actual cost for removal and proper replacement of any item which <br /> does not meet above requirements- Failure to comply will be cause for revocation of permit. Applicant agrees to indemnify and hold <br /> the City harmless against any and all losses,costs,or damages resulting from injury to persons,death of person or damage to property <br /> occuring at the site of or as a result of work to be performed under this permit. A certificate of insurance shalt be submitted to the <br /> City Risk Manager prior to beginning construction. <br /> &42— <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-800-8 2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL(209)937-841124 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions on reverse side of this permit fore sig ngtote requirement of notifications and inspections. <br /> Stgned: — --� - . <br /> Ist—PermiNee 2nd—File 3rd—finance <br /> 41th--Utilityf Street <br />