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Permit Number <br /> CITY OF EnCROACHMENT PERMn' -78231 <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY <br /> ;�iw � `�/f� ,�_�: APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant: ''''�t ops..�T_i-�-'- Date: w� <br /> Z Subject to the General Provisions and Special Conditions,and all work must <br /> GJSi 4C l�-�C� conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: Ll Ln the most current version of the City of Stockton Storm Water <br /> ZIP: QPollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: l" ti' State: I <br /> �I <br /> 2 Yti L_f LL 13y: 11��I t/VV 1y��41 Date: I <br /> Phone ? ��� Email: <br /> ssociated Permit(s): Expiration: V r 1 <br /> WORK LOCATION: 12 '7 <br /> �^ <br /> Start Date: p l Z'�I('� Completion Date:rJ 7 L I LL 15- CONTROL NU Ek <br /> "• c r�� ?<' "0 REQUEST A CONTROL <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, 24 HOURS M NOT IN <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the _ .� j? j^;(� i 0 START OF WCK <br /> parcel;remove USA markings upon completion of the permitted work. <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> < ���l,,N lar �` a ? � � 1JE'—�— s,Jc> iw <br /> J <br /> Show sketch or refer to attached Drawing Official Use Only <br /> Base Permit Fee $ <br /> Additional Footage Fee $ <br /> Misc. Tz2+ $ <br /> Misc. Lj1," $ <br /> DMisc. $ <br /> ��( �1 Total $ <br /> NtHt r �a15 Special Conditions: <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, Standards and <br /> Specifications currently in effect, and to pay to the City its actual cost for removal and proper replacement of any item which does not meet the above <br /> requirements. Failure to comply will be cause for revocation of this permit. Applicant agrees to indemnify and hold the City harmless against any and <br /> all losses, costs, or damages resulting from injury to persons, death of person or damage to property occurring at the site of, or as a result of, work to be <br /> performed under this permit.A certificate of insurance shall be on file with the City Risk Manager prior to issuance of this permit. <br /> IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE <br /> OF A CONTROL NUMBER, THE CONTROL NUMBER WILL BECOME INVALID <br /> AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. PRIOR TO <br /> ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE SIDE OF THIS Sign <br /> PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT(209)9378381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE I. <br /> SIGNING. Print tJ 1 ✓Le, <br />