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veY �;a�a rs•y,� w'.. ✓� + Ie �r.�,N Sy_-a ,� 4+rJ�,.r ''- Sr ^' T " 5 is*, s.r �i �r � t <br />„"�f��.aM'�'�� ;t},� �; w!�`- +�.,. t �"' �,��*.7t'�a.� �1 :1 �e „r ;� �,,•3- Kix` �ra �,ti6 r � tU�, e fir-� � 5 � ," �. -L ' -�..r�wi,,?. <br /> --� <br /> � � l„..x.i ,�'T. f+7��,.i�.�..,tip+; <br /> k <br /> '4 <br /> Sh <br /> r Clry OP STOCKTON <br /> �gPARTMENT OF PUStIC WotKS <br /> AOPLICAYION FOR INCROACNMENT ON PU5U'C RIGHT-Op.WAy <br /> —o 6 <br /> _ larn,totr or PrrpoeAi Woh,ere � - <br /> S' <br /> APPROVE): Di)tECTGR OF PUBLIC WORKS <br /> ,z <br /> [yslmprMd�far}Fnp raxrl����r r� tron,pl.tion Date �—�!� a — '� <br /> _ P.rma E Np lion Dot <br /> I (Or We) hereby apply Ser an encroachment permit to carry out the following wark: <br /> ar+ kl,v o� <br /> 7h*CLOtra ftn-d appiicont rgntay raq.sts,p*,,,,;on to 4�~ <br /> PERMIT FEE-._..._..- -.__..................._-. 3 54 <br /> �� Addrtiend Fwngp.�._ <br /> S+•wr Tap Deppsit ...... <br /> 1pFAl DFPr75rr ..-......... 3� <br /> e -- <br /> Building PermiI No. <br /> QA�bm;'Nld Improvement Plan No. <br /> SupPlemental Conditions: <br /> ��l 4 <br /> 3hrZ lk*lch ahav�pr M(Of 1 <br /> IMPO RTANT: Applicant hereby ogrers to comply with a!I provisions of this permit as well as all apolicabte City vr4+g ya <br /> resolutions, standards and snecificarions currently in effect,and to pay to City its actual cost for re oval and proper replace- <br /> men? of nny item which docs not meet above requirements. Failure to comply will be cause for revocation of permit, Appfi- <br /> Dant agrees to indemnify and t c 1 the City harmless against any and all lasses, costs, or damages resulting from injury to <br /> Persons, death of person or damage to }property occurring at the site of or as a result of work to be performed under this <br /> Permit- Certificate of insurarsce will be presented by applicon4 upon request. <br /> Read General Provisions on niverse aide of this permlt before signing- *Note requfremenl of nollftaaflans and Inspe,etlons. <br /> Permit Engineer!InsPector <br /> 944-0250 <br /> "4.83" p L"4.83" O yho -3 L^ 7/z 3 <br /> 2.4-400 9rq�c„prx• �Ih--Urd�ry�5ney1 <br /> } i <br />