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Permit Number <br /> F4CROACHMENT PERVIT' <br /> crrY of �� 77370 <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY <br /> 17E1-evm-Die, <br /> S'f'44eG&n5k.1-61 <br /> Nf6tsT►1G• Date: C)-71J)-71)q r APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant: � <br /> QQ,,, r'� ``������ J Z Subject to the General Provisions and Special Conditions,and all work mus <br /> �7V l KI�I� r- Rc M 5Lf 1 f G 1 01) 0 conform to the project's approved Storm Water Pollution Prevention Plan or <br /> Address: i i,., <br /> rrh the most current version of the City of Stockton Storm Wate <br /> RanG,b 95G7o Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: Cardovli. (,State: �1 ZIP: Q r Y: �c <br /> Date: <br /> AwrAk CwWina�br; a b'b►c iU4er%1 er4er 9)4-384-07124 " B �W l�/� t 0� --�(-I <br /> �YM'• DA.nfelltiMa+lnr 11l([-�$�/ � <br /> hone: dlbb�L.)iGh+cntwb�ratr�sun4e-e 1 0, r <br /> ar►tGll£'fHlinnl"J �'� G'� ssociated Permit(s): Expiration: 1 <br /> MW-5 A14040 51k f MW-(e a,-A RC 6 n 1wb d)�c(!�, ` pp <br /> WORK LOCATION:71101YI17-oZ,75 C am-trq 0.116 U11d,J& --kA1 � � ,�ti ��Pb, f6 � <br /> Te be Smcd•kd' / �,p �U{�D�y <br /> tart Date: A&cr D'1Iz6`t�f Completion Date: be �r6 1011511 N COMOL C��..��.P3ER. <br /> CALL (�'1i'3) 937-ai 66 TO REQUEST A COMM <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken, f�.�,va <br /> ,dams edrd rG. <br /> g �R N0 LESS 7NA?+124 HOURS, BUT NOT <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the EXCESS OF 72 HOURS PRIOR TO START OF=f2►Y. <br /> parcel;remove USA markings upon completion of the permitted work. r.t1 <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> -Lan,c std�el�atk F,tns�rn. dc�Ieirw e�,ll d4s-heu(*m <br /> -Side u&lk 64marc duKy)A ",4 i a6m Atkr26!4 lZ^6ya.Q ,Cep <br /> -51dt wadi( Nobat d twir!, C&iCrek t�dllfeernenr - (AlorAle eel he inw-5 ,back of d dcu k� <br /> Show sketch or refer to attached Drawing <br /> O. Ccial Use Only <br /> S e. ntbVhe l�ltre, Base Permit Fee $ <br /> 5 <br /> Additional Footage Fee $ <br /> Misc. `K—C" $ <br /> Misc. cm $ <br /> Misc. $ <br /> Total $ <br /> Special Conditions: <br /> 7 - <br /> 1013Ci -t 111&v <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 Si cG <br /> PERMIT,PERMITTEE SHALL CALL INSPECTIONS AT(209)937 8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE / <br /> SIGNING. Print.DGbbit Li�htcnbcr'gcr �n" 5faneG <br />