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` -- <br /> y yrs - 71�1J - <br /> C:TY OF STOCKTON' <br /> PUBLIC WORKS DEPARTMENT <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY ,V� G4 az <br /> + APPROVED BY THE PUBLIC V+1119ECTOH <br /> Apodcant s Name:��r c; r^,t__- zYvr s�tr I date - <br /> owner/Contractor) -Subject Ir,he General Pro +StG1S and Sceecial Cancitlons arq all <br /> + C <br /> Phon m 3��� wom must conrGrm to;he crner s aoprc,f?C Stcan Nate07011utrrn <br /> caress, -.S r'#ri_ — <br /> r Pre�enllon Pran-jr the C tv 7l s,oclncn sicrm'Jla,er 0olf►+aori <br /> _State .Z <br /> ` 'P Prevennon f„1alntensnce Start GLAdP hric�Prer is ao;}ncabfe <br /> _�Catron of-�,Ocosau work Laic <br /> Cwneri Contrac or Address <br /> .3 Jr- ,—Completion DaIF -� - erm,t ExPiradcn Dale ' - <br /> =_sumanng Starting Oaie _ <br /> 1 (or We) hereoy apply for an Encroachment Permit to carry out the following wcrk 1" ty, <br /> r " -rd, •�,=��,` ` � is ��-'�'r_ :�i'�,"'` c:. \ _5� , rte' a.�I <br /> If <br /> _ The Roave named arimcam 7BrMy requests:wmisw+ m <br /> PERMIT ;;E4 S <br /> l <br /> Additnal;octage Fae 3 <br /> (p � Trencn Fie <br /> - , <br /> ti firer Tao epos t 3 �- <br /> I �~ <br /> 1 <br /> Funding Permit No <br /> Improvement Plan No <br /> f II I Sucolem6ntal <br /> I c Cq <br /> .l,tricri au9ve rr tele!o]raM i suo-wou � - <br /> IMPORTANT Aool,cam nereov agrees,c xmtilV wilt)all provisions ^I his permit as well as all acailcaerrr Cav-e.u-ar•-as escluticzs <br /> 3,aneares and Spec itcatrons urrentiv,n effPcr and to oav'o the City IIS aCtLal cc!v for-ernoval ano:;roopr TF-olacamar, .t 3w, 'ern nic. "--s <br />' 1,3t '1i-et'he anove equ,remenlS +-3,lure,o cama.y Nrll bE cause}or revocation of permit apprrr.+nl agrf--s p r'oemr- 2r::.aC rta Z:, <br /> za•-mess against anv and all-csses -csts ,r tamages resufung frcm n'u I to persons.9eath :l-erten or 2amage -- -c-rn, =ccjr„rte,at "E art= <br /> ^r or as a result Or vcfk o oe pen:;rmed uncer'his permit A certttrcate rt assurance shall be submitter tv he C N=ss( '1aragel ar or 0'S;uarr2 <br /> 't Cts^errrvL <br /> 3=-RMIT7SHAL,CALL 1209)937 MG FOR A CONTROL NUMBER�;O LESS-HAN Ca HOURS SUT NOT Pl E<CE,S CF-2-Ct.RS <br /> P91CA TO THE START OF NORK AND a41CR TO ANY PE OUIRED'NSPECTICNS AS IDENTIF ED Ohl TIE PE E BICE -_ --IS <br />` cMiT IF WORK DOES NOT BEGIN WITHIN-2 HOURS OFTHE ISSUANCE OF A CONTRCC VLA�BER THE PI'=CL IL.Mr?E9 'hL_ <br /> �CME INVAL D ANO-r-E aFRMITTEE SHALL CALL-FOR A NE N CONT'�OL NUMSE9 EFOO CAPITAL to PRC,EME IT F=C_ECTS;a <br /> 023CIVISION INtP4CVEMFNTS OERM1T-EE SrALL CONTACT THE ASSIGNED CiTY PRC.,ECT EPjGINE--+AT 2:i9r 33: 2-1 ^�R <br /> S:5S�F C INSTRUCTICNS 091OR TO THE aEGlNNING OF ANY NORM <br /> RE=AD GENERAL PROVISIONS ON REVERSE SIDE OF THIS PE91MIT BEFORE SIGNING <br /> x- <br /> rsl Permtrtop was-tel )rd File q-lro-� -lih r-nance Iwntlel <br /> _ X�d 9E 91 i0/TZ/$0 <br />