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Permit Number <br /> �MYOF ENCROACHMENT PERMIT N° '775 17 <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY <br /> Applicant <br /> 1I7"iy s� �!t L sly Date: % /y APPROVED:BY THE DEPARTMENT DIRECTOR <br /> Subject to the General Provisions and Special Conditions,and all work mus <br /> 36'06 1>10C K C 2iz .� vim. . j" conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: he most current version of the City of Stockton Storm Water <br /> _ Pollution Prevention Maintenance <br /> eSStaff Guide,whichever is applicable. <br /> City: 5� UG.k%7J/-/ State: C4 ZIP: S� ! - \ r` <br /> � � —Date: <br /> q <br /> C)e' [ f' i ,7 (:C:* Issociated <br /> y . <br /> Phone:Z• 1 3�' � 7�G! E-mail: 1<��LJ C!IldfJ I�I:IGL•• }� a ''j �Q r <br /> Permit(s):�1 0 a:^-" 1 VV Expiration: �Jl <br /> ORKLOCATION: !>p(,U Er <br /> S Chi I r�¢ S to ZDt`� C 0L NUU- 1-R. <br /> Start Date: Completion Date: M 0W 3 2_1$ CONTROL IN <br /> NDMI <br /> ATrEN'nON:Applicant/Contractor-you are responsible to replace all broken,damaged, EXCM OF 72 NOTo SM OF W= <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the U <br /> parcel;remove USA markings upon completion of the permitted work. <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> i7 ';f2 O Y <br /> iii c7�%�+ s .v r— �/Z eh i t i. �.y !� -:f <br /> IZoc�70 <br /> Show sk c or refer to attached Dra ir4,g <br /> f )� } <br /> Base Permit Fee $ ��• �C� <br /> Additional Footage Fee $ <br /> I-)klr/ 5T $ <br /> Misc. <br /> r <br /> V rI -Z Misc. $ <br /> 1 1/I�r�7 <br /> -51 r;F7 W 40< Misc. $ <br /> Total $ <br /> !�� v�/✓J Special Conditions: <br /> V1 <br /> �- Qr����CVO , <br /> QrT u 9 131-ehV3 <br /> r <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 ANEW 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 />