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1 <br /> s <br /> ' I <br /> '* CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WRY <br /> i <br /> Appiicwr• 5 5 7 6 3 <br /> 4'� <br /> Addni SZL�/ 15t IC. _�15tf�_Phos �_._�L_. ' <br /> � +�-� �� APPROVED; DIRECTOR DF PUBLIC WORKS <br /> Loeatien of Proposed Wo-k,etc. <br /> ��fr,�'' r;�!,t�.✓%=CF-e'e��' �1f`�.�ri�"t'.7'"if+�� _......_..�—._ <br /> 8/1 rly 160 <br /> w.rrtontrwc+w <br /> &tlmated Starting Date r % r_ -Comgrelion IMta� � -` Pt. •it C.N;_e_oti DalB�-_�_�. <br /> I for We) hereby apply for an encroachmentpw_r it to carry out the following work:—�q <br /> 'r-az4E�'C Cir`' L <br /> 16 obv"nomad appll-nt ko-toy 44..e1ri Parrnillipn 16 +SCRMIT fLE ....,.,....... „,•... . ................ <br /> Sewer Tara fatposil .......................... ......... <br /> r <br /> TOTAL DEPOSIT 3 <br /> Building Permit No. <br /> Improvement Plan No, <br /> Supplemental Uorlditions: <br /> I <br /> Show fitatch abwv or:afar to drawing t,.jbrhitted <br /> IMPORTANT. Applicant hereby agrees to comply with+ ail provisions of this permit as well as all applicable City orciinances, <br /> rrsttiutions, standards and sperifirotians i ertrr,etf'y ir; affect, end to poy to City its actva! cost for removal and przper replace- <br /> ment of any item which does not meet above requirements. Failure to cornply will be cause for revocation of permit. Appli. <br /> Cont agrees to indemnify and hold the City harmless agoinst any and all lasses, costs, or damages resulting from injury to <br /> persons, death of person or damage to property ocCurririq at the. site of or as a resvit of work to be performed under this <br /> permit. Certificate of insurance will be presented by applicant upon request, <br /> Read General Provisions on reverse side of this permit before signing. "Nota requlroment of notifications and inspections. <br /> Permit Engineer/Inspeetor �'" ,r,.. , s <br /> I r <br /> 94•836 si4nad � �.' .__.___vha c 4( <br /> lit---Permrttat ZrO-�iie Jeb- a i.+once atrv�!,iity/SrreeT <br />