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E XROACHMENT PERM . Permit Number <br /> CITY OF No 77391 <br /> MZSSTOCKTON ON PUBLIC RIGHT-OF-WAY <br /> f1 __ 11 /� I ' , ie / _z y � � J APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant: , fC>t0 G �U�Y11/1✓arl ✓17it( Date: y <br /> Z Subject to the General Provisions and Special Conditions, and all work must <br /> �Y/LL/II yf ` 0 conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: /f [1 vc"i he most current version of the City <br /> of Stockton Storm Water <br /> 95z Y a Q Pollutiopn� Prevention Maintenance Staff Guide, whicheveris <br /> applicable. <br /> ,� <br /> City: �✓ I �G� State: //� ZI P: U By: �Itl l 'V'U �10411 � Date: <br /> Phone: �9 " � /1wls-t/, E-mail: aQ.[ y"& h pp <br /> V ssociated Permit(s) : Expiration: <br /> WORK LOCATION:_ EI / ' '� <br /> iii G)� o <br /> Start Date : JJ O :2 S 2AJ Completion Date: J U�I yj,)J OL <br /> un ax �� rS <br /> �o <br /> Lfi l <br /> (200) ,937-03M M REQLv�SY A CWTRM <br /> ATTENTION: Applicant/Contractor- you are responsible to replace all broken, damaged, ��f2w� NO LESS THM 241 R8WT W <br /> and/or raised sidewalk, curb and gutter from score markto score mark adjacent to the ��'io� � � � „ .� �Y �, p�,v �p <br /> parcel; remove USA markings upon completion of the permitted work. p nfry� 2 Wow <br /> I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br /> conteq (OM POAcl VU RIJrf s 8b <br /> o.. El C;,r" ,, at R Fel. 4 F if 46 [-vhlv�s .% SIYXr s <br /> Show sketch or refer to attached Drawing <br /> r� <br /> Official Use Drill <br /> /�} v <br /> S( C 4me6c (� p ISM c Base Permit Fee $ <br /> Additional Footage Fee $ <br /> Misc. $ <br /> Misc. mt $ it) <br /> Misc. $ <br /> Total $ <br /> Special Conditions: <br /> M <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 Sign <br /> PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (209) 9378381. <br /> READGENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE �� ; l� ^ . - <br /> Print ` ` AAV%Q,(3 <br />