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CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> N0- 62237 <br /> AppliconNaQ�SNA 'T1uDuSrRI Date 4-1.93 <br /> IOsrnerr,/Conme trast <br /> Addr.sullp_`( geld C T�/,niIt ,34st 2Qp Phon1e-416/-SSZ-669 <br /> Location of Proposed Work,etc. 411 r��{, W�CGt1r 'S-ry0�e)'pn APPROVED: DIRECTOR OF PUBLIC WORKS <br /> o.n,.r/ ontrxt AdMw__> [nC By. - //^7 j ppel.-! <br /> Estimated Starting Dore -1pI28 113 Completion Dole 9 bm q3 Permit Expiration Dole 1(/ '-/-/ <br /> I for Wei hereby apply for, encroachment permit to carry out the following work: 7r;l1 O.Itnek tWT61t <br /> o <br /> -inch rn ,.r+wl ells + + 0_ <br /> Ci V <br /> Th. above nomed applicant hereby .equesis permfsslon to PERMIT FEE ___ $ �17 Ov <br /> Additional Footoge Fee._.............. ...... _ <br /> Sewer Top Deposit .................................... <br /> TOTAL DEPOSIT ........................ $ 20 t7V <br /> Sec P'crk 2 Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> Show sketch above or refer to drawing submitted <br /> IMPORTANT: Applicant hereby agrees to comply v/ith all provisions of this permit as well as all applicable City ordinances, <br /> resolutions, standards and specificot'il ns 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 requirements. 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 damages resulting from injury to <br /> persons, death of person or damage to property occurring at 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 General Provisions on reverse side of this permit before signing. 'Note requirement of notifications and inspections. <br /> Permit.fng I n ser I Inspector <br /> 944-8250 <br /> 944.8388 Signed, C./' '�!�!) ( G� Phone 9/b— <br /> 1 <br /> 1st-Fe.mittn 2nd--file 3,d Fmonce 4th-Utility/Street <br />