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12-26-19% 3:WPM FROM P. 2 <br /> ` hitt-GS-1'!Nb 1S=GU '<L ll. WLtt(Kt, -tHnIi k-Er4lK ,hi,ilfj 1:07 &-441 V.0.'- <br /> CITY OF STOCKTON 64143 <br /> 0 DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION POR ENCROACHMENT ON PUBLIC R161011•0E-WAY <br /> �40DDeto+fs Nanw EliYll�1:7 )NG circ 12/3( 9V - <br /> lQ.rrarlfq!iridp.l <br /> •darns ED_OOK.3Sl�..--- �c+�4_CP. 9O4'7L Pr!P,w�T177�9DA._ <br /> APPROVED: P116UC WORKS DIRECTOR <br /> {.00iUO^PI PnIPPN'd w0,k 1R __ <br /> /Z Sr'� <br /> X Ee-ard Vw"vire Zgahh—a- 01 `-y__. Ar•!Okfron Hats �QIT .Z, iQ'�'/ Wrmm[isifao!,oiP. r�P•4't ._1L2. °�°..l:7 <br /> I WW!)hereby apply for an encroachment permit to cavy out the tollowjng work! --44S-VbL - <br /> Cava a a.saltr- Ma 1.tO <br /> 60l 1st <br /> tint iOWr wised raOVtW�inb1 TWM\M^^Ywn!e. PERMIT IEE S ---12la e <br /> n[NIRMi� F <br /> Sfi'ar TO p90"A ... <br /> Sly 1�iti?aCvED - <br /> rprnt DEPOSIT <br /> 8wloing Permit No <br /> Improvement Plan No. <br /> Supplemental Conditions- <br /> O-ONN toe s1 <br /> S,clr � r olot� Ave- Otyrllw+h @ <br /> Fco.s�uc�e , <br /> sac+M.td'.rw a!444 a PaiK r.AmiMJ <br /> IMPORTANT.Appheam hereby agrees to comply with all provisions of This permit as welt as all appkable Coy ordinances,resuluuons. <br /> Standards and specification$cuffemly in e0ecl.and to pay to City its actual cost for removal and propet replacementof any item which <br /> does not meet above requifpnentsFailure to comply will the Cause Tor revocation of permit- Applicant agrees to indemnity and hold <br /> the Gly harmless against any and all bases.0056.or damages resulting from injury to Persons.death of person or damage to properly <br /> occunng at the site Of Or ae a result or work 19 be perlormed under this permit. A certificate vT insurance Shall be svhmdtad t0 the <br /> City flmk Manager prior to beginning CMslfvvfivn. <br /> PERMITTEE SHALL CONTACT UNOER6ROUN0 SEIWICE ALERT tl-90044P--24441 TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDEROAOUND UTILITIES. <br /> PERMITTEE SHALL CA"IZ09)957-[417 Z4 HOURS pWR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read GenePrOvn <br /> ral lsloa on feeanPermit <br /> e side Of tbiS belore signing— NOW requirement of not"'Callafs and inspections. <br /> ,�.p., -7o7-f3S y85y <br /> l^O-fVe����rGr��hi fi�inuR" xn-N.�VY•S,�! <br />