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SENT BY: SPECTRUM EXPLORATION; 8-19-96 13:27; 2094658773 => ; ffe14 <br /> rCITY OF STOCKTON f)4 0,j Y <br /> DEPARTMENT Of PUBLIC WORKS <br /> AD APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF- <br /> WAY <br /> iprtnar (facto /t� �.L f <br /> Address. S....�-2 w( ►�-._!Y1• 64 Phone 44,5'.ef.�l l-L. <br /> Location M Proposed Work.aac. aM^td"C41! SII{�w- /YIC.rbc APPROVED: PUBLIC WORKS DIRECTOR <br /> Owner/Cx ntractor Address (Z - <br /> Estirnaied starting pateGJ <br /> ��+ � _ContcTtetion 17.i1e Qg -f Q.'."- // � <br /> F. ��rcY PefnhI f>cRtratitm vale <br /> I (or We) hereby app/ for an encroachment permit to carry out tho following work : 1Dr+ i[. j ("t S <br /> ThB ahmm rwmed apPkram pereq rnquosts nenn;; to <br /> PE'1iMiT FF E f �Z� <br /> Additional FrnaoVv Fee <br /> Sew(,,Tap Depwl i <br /> J(PAL DEApSTr S .... `L� <br /> Building Permit No. .—._ _..._-... <br /> Improvement Platt No. <br /> Supplemental Conditions: <br /> Shc.��� <br /> Q(..sl'Cjt->JC.�U P.T fias•>.`.r'C't�,P= <br /> Ove-��, �-►'.� c.oJh� � <br /> tino..s4ew'.1h.—v,•efer to far irv,.,g sutVtnaten <br /> IMPORTANT Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, rosolutions. <br /> slat dards and specifications currently in effect,and to pay to City its actual cost for removal and proper replacement of any item which <br /> does mot meet above requirements. Failure to comply will be cause for revocation at 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 dar"age to prvperry <br /> occuring at the site of or as a result of work to be performed under this permit. A certificate of insurance shall be suvmitled Iv the <br /> City Risk Manager prior to beginning construction. *4vl <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-900-9422444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL(209)937-641124 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions on reverse side of 1"s p mit before lignin —. Note require nt of notifications and inspections. <br /> t,I a+nrntlr.tJnR -filN :l,t! irit.t,t,r .1•t. tl!,1[y:`::....i <br />