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CRC Env. Risk Mgmt . , In ID:17144768211 SEP 26 '95 10 :30 No .002 P .08 <br /> CITY OF STOCKTON ;; '•'' <br /> DEPARTMENT OF PUBLIC VM;IKS <br /> Aa APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Approanrs same Amirrican Savings. Bank oats Aug 1,14-9 <br /> lOwneAWre rcoT97917 Von Karman, <br /> /Y}presa...--l--I-..t_3_... 4 t]� .Fl..r Qnone ---- <br /> Location of Prrooposed&k ai _._..22 Y'PGsfi......._.. �PRt]I�E'Qt Lo1Jl�.IC WRIRItB DIRECTOR <br /> Stockton, CA A,/ <br /> ownertt rmtractor Aaarags �i�nv� _._._..._. . . _. by-_J901 "l'lr c — <br /> EAtirnawd Starling Date q5' comptstion Dtgu L-KPtrsoon Date <br /> I (or We) hereby apply for an encroachment permit to Carry out the following work. Install-_.nne... ground.. <br /> _.—water monitoring well in the .sidewai]�,_n, _ Y�e...,cU_r_ner.�._._ <br /> Channel Street and North El Tlnradn. <br /> The abnea named a"Iment hereby requests parn4aaKm1 W PERMIT FEE.... ....... ..... -- <br /> She soil boring location Add[WnalfWageFee............. •-- ---.. <br /> map in attached work plan Srwer Tap Deposit ................ <br /> T01AIL DEPOSIT.........S__Building Permit Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> 0 <br /> Sh sketch above o refer b drawing somined <br /> IMPORTANT Applicant hereby agrees to comply with all provisions of this permit as wail as All applicable City ordinances,resolutions, <br /> standards and specifications Currently in affect,and to pay to City its actual cost for removal and proper replacement of tiny 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(1-800.642-2444)TWO WORKING DAYS BEFORE SE43INNING <br /> WORK FOR LOCATION OF UNDERGROUND U71LI'TIES. <br /> PERMITTEE SHALL CALL(209)937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUfi M AND TO SCHEDULE <br /> INSPECTION. <br /> Rend General Provisions on reverse side of this permit befum signing«-Note requirement of notitications and inspections. <br /> Phone <br /> lei—Petmhbe 2,M—Fib 3rd—Finance 4th-Ui QyfS*M <br />