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RUG-31-1994 13:28 •1BLIC WORKS PERMIT CENTR • 209 937 8901 P.01 <br /> CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PU66C RIGHT-orWAY <br /> faw {c- G9_44 H)ecMe, C'o• N° 62302 <br /> APN'icant's N10 G D1re3s�/f../M <br /> I n.e .Q 7 ^�A 4. 1 L2 P�ti,rn f�e7 <br /> Laemlon of Prapesed work,of tin d7irthi _ sEF APPROVED: DIRECTOR OF PUBLIC WORKS <br /> r O ' <br /> AO~ ea nmr � Q, <br /> )/;i, e"(a —Dare <br /> A nirg Camplarioa pee5u /� <br /> Permit Expiration Dor. 3— l <br /> 1 (or We( hereby.apply for an encroachment permit to carry out the following work:���j7 <br /> O � • <br /> . .- The above'named applicant hereby reger permission to - <br /> 'q''��y� .,tJ��)�..(�y.. PERMIT FEE.,:;.. :. ... i . <br /> =1rn1VrFm/'N Qi�`q /.dditiv+d Foofaac rice . <br /> Illont ri wells on CtT;vU t.4 Storlse yj <br /> w� 9ewerTop 0.pwi1 ........... <br /> ri8},rt <br /> "at? s5 /Sod )4 the a�ah_,d <br /> d0gtpove� p! /�Z�• WOYR���J� TOTAL DEPOSIT . .................. S <br /> G � •r1 �l71lat 2 ` � r ert �r Building Permit No. <br /> Improvement Plan No. <br /> PJJS V/ueY �j� � �008 C�S� Post-It brand fax transmittal memo Nor pages . <br /> To <br /> g7171 <br /> P F a �_ 7 <br /> Shaw sketch above Or mfw to drawiry wbmined <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, <br /> resolutions, standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replace- <br /> ment of any item which does not meet above regvicements. Failure to comply will be cause for revocation of permit. Appli. <br /> cant agrees to indemnify and hold the City harmless against any and all losses, costs, or domages resulting from injury to <br /> persons, death of person or damage to property occurring of the site of or as a result of work to be performed under this <br /> permit. Certificate of insurance will be presented by applicant upon request. <br /> Read Ganes[Provisions an reverse side of this permit before signing. •Note requirement of notifications and Inspections. <br /> Permit Engineer]Inspector <br /> x 9444250 / <br /> 1144-8388 SP; � _Phan <br /> hayer� Sarv�c�s <br /> isr--iermittx ]r.y—pi4 3,d F, Qme 41h—1pp,fyRnee <br />