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APR-19-1999 09:07 PUBLIC WORKS PERMIT CEHTR 209 937 8901 P.02 <br /> • CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS CJ:J U <br /> ° APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> A;P <br /> Co. Date 3/22L"_ <br /> A pbcanVs Name <br /> {Owner/Coecll0[' 5 l r'a I�- O <br /> Address _, Phone APPROVED: PUBLIC WORKS DIRECTOR <br /> state — zip <br /> Cm <br /> Location of Proposed Work,etc <br /> t <br /> By tom.j�p„ Date <br /> Owned Contractor Address 412771 Permit - _ <br /> ¢ � Completion Date 12" Permit Expiration Date <br /> Estimating Starting Data <br /> I{or WI hereb apply <br /> for an enroachment per it to carry out the following work: i to <br /> r • <br /> r <br /> II1 The abo•n named ePPi—t horeoy reauast-.permlge"on fc- PEFIMIT FEE................................... S <br /> 11 nn Acidmonal Footage Fee,,-*-,-,,*,,*...........S <br /> Som d1 Ql�o1L IV11�Q flow- <br /> / t Sewer Tap Deposit ................... ...... <br /> TOTAL DEPOSIT S �� <br /> Building Permit No. <br /> JJ r7 ( }� �0 Improvement Plan No. <br /> R,I pal Aviles `w�) "a" Supplemental Conditions: <br /> ft';-_'Nuu "S iii <br /> iso �� � P�SZirr�f.C� W N�1tS <br /> Show gxetch above or rervr to drawing'cubmrued <br /> Perm <br /> as well as all applicable City ordinances, resolutions, <br /> IMPORTANT: Applicant hereby agrees to comply with all provisionCity s of <br /> cost for removal and proper replacement of any item which <br /> standards and speClfications currently in effect, and to pay os <br /> does not meet above requirements-I losses, s10 c ory will be damages resultinglfor revocation <br /> antj injury t persons, death of person or dam ge to pr Property <br /> City harmless against any and,all o <br /> occuring at the site of, or as a result of. work to be performed under this permit. A certificate of in <br /> shall be submitted to the City <br /> Risk Manager prior to beginning construction. <br /> ERT (1-800-842-2444) Two WORKING DAYS BEFORE BEGINNING <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE AL <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL(209)937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions on reverse side of thi permit efor signing - Note requirement of notifications and inspections. <br /> Phone' <br /> Srgned.__ <br /> 2nd-Fite <br /> 3r6Flnance 4th-Ul1BtylSlruml �`�/� a <br /> r�.PtrrmlRee <br /> TOTAL P.02 <br />