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CITY OF STOCKTON <br /> RKS DEPARTMENT <br /> AIlp"CATION� ENCROACHMENT ON PUBLIC <br /> RIGHr-of-wAY 7 515 5 <br /> Applicant's Name i q ` <br /> (Owner/Co tracto Dale �� APPROVED: BYTHE <br /> � <br /> Add ess` t Y„- / w6RKs DIRECTOR <br /> ty V- Phon� -1010 Subject to the General Provisions and Spacial Conditions, <br /> -st�gt$=kms_Zip qr� y and all work must conform to the prefect's approved 6torm <br /> Location of Proposed Work, etc. t� '-``�'=�— Water Pollution Prevention Plan or the most current version <br /> '• "n r CC_ ln 154-._ Of the City of Stockton Storm Water Pollution Prevention <br /> Maln[en o Stag Guide,whichever Is applicable. <br /> Owner/Contractor Address ,� <br /> Estimated.Starting Date V, By -� bate <br /> Completion Date <br /> Permit Expiration Date- <br /> (or /^ <br /> I We)hereby apply.for an Encroachment Permit to carry Out the following work: <br /> 1'�Y'cN 1 IA <AjjAp,nea�&A <br /> �cL1=7 a.�tu�OLv <br /> ATTENTION:AppRcent/Contractor-you are responsible to <br /> replace all broken,damaged,and/or raised sidewalk,curb and <br /> gutter from score mark toscoro mark adjacent to the parcel; PERMIT F $ <br /> pr <br /> remove USA markings upon complegon of the permitted work, <br /> r_hhottahovo named appgcaM hereby raquoslapormisalon lo: -A drN6Rg $ 9 _3 <br /> SC 0t4 BB.......... <br /> " r �71 Sower Tap( trp s .......... $ <br /> TOTAL DEPOSIT ....... $ 7 1 <br /> VaAAe <br /> Improvement Plan No. <br /> Supplemental Conditions; <br /> PERMIT NOT VALID WITHOUT A <br /> ONTROL NUMBER. <br /> ALL (2 09) 937-83(it} TO REQUEST A CONTROL <br /> 1UMBER NO LESS TWIN 24 HOURS, BUT NOT if, <br /> XCESS OF 72 HOURS PRIOR TO START 01=WORK. <br /> Show ahotch above or rotor to drawing subrolasd <br /> 0Nrrzc�Lt� <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit,as well as all applicable chy ordinances,resolutions, <br /> Standards end a above r9 s currently In effect,and to Pay to the City Its actual cost for removal and proper city <br /> ordinances,ances, es Item which <br /> does not meet the gains requand all irements.Failure costs,comp y Will because for revocation of refs permit.Apro er t agrees to indemnify and hold <br /> occurrithe ng at harmless to Issua or as any <br /> his permit,losses, to be pe�armed and©r this s Perrming from t.A ertitc ale of IasmanOf shall be r damage <br /> age to property <br /> Gly Risk <br /> Manager prior a site f,Or of a this permit, <br /> tted <br /> IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE OF A CONTROL NUMBER,THE CONTROL NUMBER WILL <br /> BECOME INVALID AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER.(FOR CAPITAL IMPROVE94ENT PROJECTS OR <br /> SUBDIVISION IMPROVEMENTS,PERMITTEE SHALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT(209)937.8411 FOR SPECIFIC <br /> INSTRUCTIONS PRIOR TO THE BEGINNING OF ANY WORK.)PRIOR 70 ANY REQUIR SP IONS,AS IDENTIFIED ON THE REVERSE <br /> SIDE OF THIS PERMIT,PERMITTEE SHALL CALL(209)937.8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEF E SIONI <br /> i <br /> Signed: �S <br /> PhoneC�-) <br /> 1"-Permittee(while) <br /> 2'"-Inspection(pink) 31d-File(yellow) 41'-Finance Finance(while) ' <br />