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Permit Number <br /> �cS <br /> ENCROACHMENT PERMIT CITY X14,-w16 <br /> TO//CKTON ON PUBLIC RIGHT-OF-WAY <br /> Applicant:DLY� Data: /Y J APPROVED:BY THE DEPARTMENT DIRECTOR <br /> q O Subject to the General Provisions and Special Conditions,and all work must <br /> N conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: �� 9 uWs he most current sl o of the City of Stockton Storm wate <br /> City. State. ZIP.qs�.�' u <br /> Polhill 'Prev end Malntena 2�SIaH ulde,whichever Is applicable. <br /> - -_/) oats: 12-3-1$ <br /> Phone: dtl'�- �L 3 7 E-mail: ( f p <br /> 2 ssociated PermR(s): Expiration: <br /> WORK LOCATION: �)L(- S �T f h"NMI f PIG i ttl ID V1I HOUT A <br /> Start Date: DCompletion Date:6�' 7�1// cr)HTR 0L Nlle'?P,r..�., <br /> CP!I-900)W-<<3G0 TO I(F01=3'1'A WWROL <br /> ATTENTION:ADplicant/Contiactor-you are responsible to replace all broken,damaged, RMAER NO=114M 24 tAffi,BUT NOT IN <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the CXCIFSS OF pj FOURS PRIOR f0 s31'ART[W WfOM <br /> parcel;remove USA markings upon completion of the permitted work. abtUTRI LVLU <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: 1+11s EIY <br /> Show sketch or refer to attached Drawing Official Use ONIV <br /> Rase Permit Fee $ 523. ou <br /> Additional Footage Fee $ <br /> --f� kf-7--'At-mm Misc. CeS Ftle�7 <br /> Misc. Tc¢f1 Fr-F— s 39,23 <br /> Misc. $ <br /> Total $ Sl <br /> Special Conditions: <br /> 3�3 f 3z yG <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 fity TaM gainst any and <br /> all losses,costs,or damages resulting from injury to persons,death of person or damage to property occurring ay the site of,or as a resin of,work to be <br /> performed under this permit.A certificate of insurance shall be on file with the City Risk Manager prior to issu7ssce 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 /> ANU 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)937.8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br /> SIGNING. Print <br />