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4, � -.001 6930 <br /> Qj CITY OF STOCKTON <br /> V� DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> CrT�! QF S�ocK�aeJ f t�xuta(a M 2 1LR11 / off <br /> Applicant's Name ~''BLACK & VEATCH Date 3-26-98 <br /> (Owner/Cont2 fib CLAYTON ROAD, SUITE * phone <br /> Address U (510) 246– <br /> Location of Proposed work.etc. NORTH CENTER STREET 8015 APPROVED: PUBLIC WORKS DIRECTOR <br /> Owner/Contractor Address * 1200, CONCORD, CA 94520-1200 B <br /> y Date 4Z"3 /96 <br /> �J- �Estimated Starting Date l7- a9 Completion Date Expiration Date <br /> I (or We) hereby apply for an encroachment permit to carry out the following work : GROUND WATER SAMPLING LOCATION <br /> FOR THE CITY OF STOCKTON S►d7 <br /> The above named applicant hereby requests permission to- <br /> PERMlT FEE..................... 5 1Y+f <br /> Additional Footage Fee....:........ <br /> SEE ATTACHED MAP Sewer Tap Deposit ................ <br /> TOTAL DEPOSIT......... 5 <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: - <br /> NQ '�2p-V e:1� Ln iad`-C C-- <br /> Show <br /> Show sketch above or refer to drawing submitted - <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, resolutions, <br /> standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replacement of any item which <br /> does not meet above requirements. Failure to comply will be cause for revocation of permit. Applicant agrees to indemnify and hold <br /> the City harmless against any and all losses,costs, or damages resulting from injury to persons, death of person or damage to property <br /> occuring at the site of or as a result of work to be performed under this permit. A certificate of insurance shall be submitted to the <br /> City risk Manager prior to beginning construction. <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-800-842-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL(209)937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions on reverse side of this permit before <br /> signing f—j�Note requirement of notifications and inspections. <br /> Signed. Phone_C51()� 2�6�8015 <br /> 1st—Permitteeni d—File 3rd—Finance 01-1.]Utyl Street <br />