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SENT BY EMCON 7- 12-96 : 7 22AM : EMCON SACRAMENTO _ # 2 / 2 <br /> d CITY OF STOCKTON 3 9 5 E) <br /> AD APPLICATION FORDWONR RO HMENTENT OFBLIC ON PUBLIC RIOHT OF-WAy <br /> Aanlicdnt's name OAC o AJ Dale � /! l � eJ ` <br /> (ownenca(n/ua�nor) - .— --- -- --- <br /> Adtlres9 '. .i-,�l�r tA,w� A—wD _ Phone <br /> i( (aZ�� a <br /> Lowt�i�on�of proposed work. etc. _ 1 (a- AS&q+�L fI D n ad O APPRWEID: PUBLIC WORK& DIRECTOR <br /> Owner/ Gbniractor Address �dLn <br /> -- vCr L Date_ <br /> Esumated sterling oar. JtALi, t-I T9. L completion Date . I� t Z& 4 <br /> -- _ _ — — _ +) —PemtErpllatanDal _.�yS 30L49�C <br /> I (or We) hereby apply for an encroachment permit to carry out the following work : _/-T p2 6d[ _ .2101ClL <br /> o�tc-^ ts11 ' �dJ�tu , ll4� 9�a�Qae�u� I g � rtlll ^• i <br /> sir CLh�h�ti�►J.c$-u��n� ��i-- � �Z��_�-L — — - <br /> me aoo.,, named onneeem nanbr mnueee oam�ae�n, ,o <br /> /rte PERMIT FEE . . . . . . . . . . . . . . . . S__ I ZO � O <br /> QO Addklonat Footage F" <br /> Sewer Top Deposit- — <br /> "Oro P4 • <br /> L <br /> Ue (ADO TpTAL DEPOSITBuilding Permit No.Improvement Plan No.Supplemental Conditions: <br /> YnC54t�/lenow ssenind <br /> IMPORTANT Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, resolutions, <br /> standards and specificaiians currently in effect, and to pay to City its actual cost for removal and proper replacement of any item which <br /> does not most 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 (1.8042444) 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 ANp TO SCHEDULE <br /> INSPECTION, ^ <br /> Read General Provisions on reverse side of this permit before signing — Note requirement of notifications and inspections, <br /> aian,,,. - ��TQftleGo - <br /> Priam 6 <br /> _ enn, 9.23 -3300 <br /> 41h <br /> —Ufilby ,Slmn <br />