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- C <br /> CITY OF STO TON K <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br />' ApOcanis Name American _ Sayings Bank Date AU9 1-,1995 <br /> townericar Ir c <br /> AddreSS 7 Von_ Karman__ 4th Flr Phone I <br /> Irt*ine CA APPROVED: PUBLIC WORKS DIRECTOR <br /> Location of Proposed h.rk. etc. 2 2 2 V ti41 _O r d C Q__S t.�e e t <br /> Stockton , CA <br /> �. <br /> Owner lContractor Address Abo3rP-^ _ __ ___ � 8y_ 9r� Date <br /> Estimated Starting Date J `� Completion Date Permit Expiration Oate f 7 <br /> I (or We) hereby apply for an encroachment permit to carry out the following work : I <br /> water monitoring well in the sidewalk <br /> of Channel Street and NortbL El norAdo- <br /> The above names applicant hereby requests permission to- PERMIT FEE <br /> See soil boring location Additional Footage Fee <br /> ' map in attached work plan <br /> Sewer Tap Deposit <br /> TOTAL DEPOSIT $ <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> ,t <br /> ' Show sHetch above or refer to erawinq submnreci — <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 /> r INSPECTION. <br /> Read General Provisions on reverse side of this permit before signing — Note requirement of notifications and inspections. <br /> ' S.gneo _ .._ Phone <br /> ist—Permittee 2nd—File are—Finance 41h—Utility 7 Street <br />