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Permit Number <br /> Z11 <br /> CITYOF ENCROACHMENT PERMIT 7 7 7 1 1 <br /> STOCKTON / ON PUBLIC RIGHT-OF-WAY <br /> Applicant: gR'k� �` '1D f0f UA Date: 11DLZZLZOI9 APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Z subject to the General Provisions and Special Conditions,and all work mus <br /> (Q� 7-mae ( -, 4-e r• Dr. &V�I�-P I v� 0 conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: _ yt t�n T ` LLJ <br /> Ln the most current version of the City of Stockton Storm Water <br /> D ,�� 1_ `! y� Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: Ty/� C Ip1.0 C�'d a State: ZIP X156 -6 Q , , <br /> Phone: aM` E-mail: rtdLLBy J <br /> IV VV V 1Ci �U�V Date: J �' <br /> 410) n9 — ssociated Permit(s): Expiration: <br /> WORKLOCATION: Glm(M mygp o�+ A, �w MW <br /> Start Date:^��?j- - Completion Date: CONTROL' NU'71iG�ER. <br /> �— �__ 1,5- 7— —15 CALL (20-9) 937.8356 TO REQUEST A CONTROL <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, NU 11ER NO LESS TNAN 24 LI KA . BUT NOT 1N <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the EXCESS OF 72 HOURS MOR TO START OF`NORK. <br /> parcel;remove USA markings upon completion of the permitted work. CON MO <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> DestT-UC+,wMyvW1'1iWr1h4 wklls in t1--e Pc�hvkg 1aAA � <br /> `�Irvmwoad Aye1r�►dvw ut- . <br /> Show sketch or refer to attached Drawing <br /> �p� fie,, �n� �p ��,{� Official Use Only <br /> l WASP_ � '`e4 % 4`-� �' ` Base Permit Fee $ <br /> Additional Footage Fee $ <br /> Misc. T�w <br /> Misc. MS <br /> Misc. $ <br /> Total $ S17-69 <br /> 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 TO01� <br /> r <br /> ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE SIDE OF THIS Sign <br /> PERMIT,PERMITTEE SHALL CALL INSPECTIONS AT(209)9378381. C� <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE Print f-�t'I pT <br /> SIGNING. <br />