|
0 0
<br /> g 23 05 04r01p City of StocktanPW-Permit (209) 937-9901 P. 1
<br /> `'• .� r."":) .iJF " {'!,„'` r, 'WMawr.
<br /> rawT1JV' Si J.
<br /> ;=K. CITY Y aF srocKTONa :. .
<br /> PUBLIC WORKS DEPARTMENT `•M
<br /> a p APLICATION FOR ENCROACHMENT ON PUBLIC RlGkT OF-WAY
<br /> 't• �1. ...yy'. L ' n6, ;:r'l i.;'r",... . : :.. '., ]!^A:ri•...u•'p;F`IBaia:1{J�,
<br /> Applicant's Name (/h(_1[R/lr h7 a fr✓ebiwYI ate APPROVED: BY THE PUBLIC WORKS b)RECiOR
<br /> .(Owner/Conlrad rl , . . ., . . •,.•:
<br /> R.
<br /> Address, � /r {. phone( )9�?-l[slZ .Subject to the General Provisions and 5peciatConditlons,
<br /> Vi. , _ anrlall woSi moat contonit to the io ea s a rovetl Storni
<br /> City uF1 " S� ZiP�41b� Water PoUhg¢n'Prevention Plan or the riios tCuirtintverslvn
<br /> of.Propdsed Wbrk;etc, � • :s•Fr;�. fS,he Qllyofi$tpak(on Storm Water Polluy n P..ra+idnlicn.'
<br /> "r .•'M' .. :.ln ' � �. 6' '-✓ :t• + ': A)ltten Fe.Sjaff,Guld,@,whichever'iSapp�lcablu.
<br /> OWnedContractorAddrew Q ; a'dr '' £
<br /> i,• r i; a,::, . 47
<br /> .Estlmated.5taning Detc '`' �'•, , - a
<br /> Completion Date RennS
<br /> I(or We)tiaraby apply for aa,Encroactanertt Permit to cairy out the follovrirl$Work:
<br /> C
<br /> (: «;
<br /> too
<br /> Pu! dY.' l f o
<br /> •, •., . . /
<br /> ATTENTION:App- ---
<br /> to 'e
<br /> replace-all broken,damaged,end/orrawd sid6i4k,curb and :"If:' ;t; PERMIT FEE .:::::..:.:.......::: .$
<br /> gutter from score mark to score mark adjacent to'the parcel; '•,.',��; '•'•y.:• " '.;; ., ..
<br /> remove USA mafklnps upon completion of the permitted work, ,•. ;, pddlUonal Footage Fee......,., $
<br /> "TM aOab 5MU allnnl naraOY/agYa1l nlrrrAulerl fe: l/ ' " )i f... _ .
<br /> $
<br /> "r er;.•..¢4,:y. :'r$ei.'errap f3eposilt• .r.r...,..,,' $• „•
<br /> wEs• ; ;; I.n: 1::..ry.:,. ,.Ir. AL DEROSI7
<br /> .l'j. .H>'n• :r.k:;' ,Y::' :'.r.,f,; $ 'i�� -�''j'r,:
<br /> 1.
<br /> Mie'"n't -i rh(j
<br /> Fr V\ 8uildinq Penm No.
<br /> ,rJ Improvement Plan No, t
<br /> '�`+r ..`.' 1 w' �,','�, (�,;,�1�Q •' i
<br /> d
<br /> Supplemental Cbnitohs:
<br /> r Vt, .
<br /> W •�;;, a � '" `::Ttie�: wP/i � •
<br /> b «� , ...,+. � .L;,:,e'' ,1.• .Y',t/1, I JC '/j i� X L0.'u f''�f
<br /> ..� •yr,r,,:...,.. .1'" '' :I.' ':L+','!�n Frs}rc, _ ,�L x} ��t, • .I.:!��4`-�"��,r.''�"'''t?i?�...r 1`Sr�'�a: :.sa�r:a.' 1-,.
<br /> 1 tahaw
<br /> gr rel rto '� n !r'.,• '�.. v ..Y�.. q� .1' alN�.,:.tAs:.rf:i:
<br /> . oarry:a lYeTlrge •r''S:', :'.�•,5/i '�T,.�:.,.).,
<br /> IMPORTANT.i.APplleant f a, reed to p y p '
<br /> SS Y g can I with all roJlalans of Inla pirinit,as well an all appllrable Ckyordlnaneos,resoluugns.
<br /> des 51 and. e-abo anon currently In ettgpt andto pay to Iha City Its actual.cost for romoval and proper replacement or any Item whlch
<br /> doge notineoUJte etiave rer ant 11
<br /> lyre to comply will because for revocation of Ihla e
<br /> the Ct�l1-,y{,hermlees e0�nst any gdd bll,l a costa,gr da Permit Applicant a9mMs to indemnify and hold
<br /> ocguRlne a qhs silo o4'or sa a result or, r msaoi resulting(me,INury to Persons,death or person or damage la property
<br /> Manager pr or to Issuance car this work t`o ha pedorm,d under this permit Acertifcate of Insurance shall pe submmed tomo City Risk
<br /> permrL
<br /> . . rarta 1 r+ tS lr f , .i f
<br /> �PERMI77eESHAIII,,t'ALL,I�.Pa)a37.ea66FOlYACO S�4, ,a 19.t , .s.,,,,,. , st t .., ,
<br /> r :.TOTHESTARTOEVrBRi�:ANDPhI' RTO'ANYgEQUIREDIINPECTIp�B,Ep,tp TFIEOoNg.BugEyER 1pico4F�?,HEoRu ¢TION"h.``i
<br /> "WORN DOES'H07 COMMENCE ITHIN;7S',HGIIRffiGF THE 139yANCE.OF; �N ��
<br /> :,- ,iNVAIItlAND TNEP.ERMIT.TEESNALI:OAttipgRkN6yytCONF(tOL'NkM Ek TOOL:PNMOEM111F.OdNTiiluL DERWI(11jECOM�'
<br /> -IMPROVEMENTS,PEttMITTEE$MALL C,ONYAI.`T TH�f1$y�IliN):OC �y P CAPIT/)L)rAPROVIetdENTPROJ&QTg U D
<br /> INSTRUCTIONS PRIOR _EQN RS 9 IYISION.
<br /> TG•711E BEGINNINti OR ANY ORK1h baler , etERATr it9B)1i37441f.FOR PE PIC I r , .{3-
<br /> :..,:. hr '... ,: f•� .' W,, {ri:. �T-`,•itl+r UJ�I`•l k�l' i�•) ib
<br /> EAOG�NERAL PROVISION90N THE REVERSE SIDIii OFTH19 PERMIT'BEFORE SIGNING it r , �.r..,(rr,;, �;;1 •� r. 1 )'.R, ,;
<br /> �' Igned:/�' �9 r'•r
<br /> Phone: //i:r`�9L r16 y1., r
<br /> -1 'd
<br /> Mi 'ON S301A83S 4 AMAS 1VAINNO8103 NdZO:S SOOZ E MV
<br />
|