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2900 - Site Mitigation Program
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PR0523459
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Last modified
12/10/2019 9:30:07 AM
Creation date
12/10/2019 8:51:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0523459
PE
2959
FACILITY_ID
FA0015853
FACILITY_NAME
TYCO ELECTRONICS (FORMER)
STREET_NUMBER
1856
STREET_NAME
FIELD
STREET_TYPE
AVE
City
STOCKTON
Zip
952032037
APN
13339003
CURRENT_STATUS
01
SITE_LOCATION
1856 FIELD AVE
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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l CITY OF STOCKTON <br /> � PUBLIC WORKS DEPARTMENT �'i1 r� r) ,.;�'; 6 9 9 2 2 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT <br /> � �QF-PAY �f1j•5�(oQ!{[l <br /> p AR ( h . ii: I- <br /> Applicant's Name r�UL �r,T J �t>-T4i 'Tkal Date C2 ZI-i1(;, APPROVED: BY THE PUBLIC WORKS DIRECTOR <br /> (Owner/Contractor) <br /> Address h4ci W �I�1 � AVE, Phone G$ L�2-ZJ�Q Subject to the General Provisions and Special Conditions, <br /> Cit `S I GC(C r0� State 6�_Zip � and all work must conform to the project's approved Storm <br /> y qS�5 Water Pollution Prevention Plan or the most current version <br /> Location of Proposed Work, etc. �j}0-t�j�(!�- /, I r �e ..� of the City of Stockton Storm Water Pollution Prevention <br /> Maintenance Staff Guide, whichever is applicable. <br /> i�sty I-tl2i.� �tUk-. <br /> Owner/Contractor Address(� �jt4-�,�'�i SA,y Jo5e,t. By Date <br /> Estimated Starting Date () (,,) Completion Date 03-31-0(6 Permit Expiration Date <br /> I (or We) hereby apply for an Encroachment Permit to carry out the following work: ADVM.Ljr_ 6jf( 1��1V117-C'�MCr.T!'TRL <br /> - Td�iL adft"r r CAA UM1 �L murk <br /> Et oilnlTf b ]>IQECrDtdSl ITcCiIN1 1X-r� L/� TillCR VI,L-L $k pI)VAdL�J� <br /> Zk( T[4''k-- G4fY/_iW1-r- LAML Id p,ib r7 QI )_u5 L Fik. "All& — <br /> ATTENTION:Applicant/Contractor-you are responsible to <br /> replace all broken, damaged, and/or raised sidewalk, curb and PERMIT FEE........................... $ <br /> gutter from score mark to score mark adjacent to the parcel; <br /> remove USA markings upon completion of the permitted work. <br /> Additional Footage Fee.......... $ . <br /> The above named applicant hereby requests permission to <br /> Sewer Tap Deposit.................. $ <br /> I l�Llj �V1zaSU TOTAL DEPOSIT ...... $ <br /> Building Permit No. <br /> Improvement Plan No. <br /> �PIZOPoy.;,D 8d-lil. r LrtAlfwtii <br /> Supplemental Conditions: <br /> I�gS( FIELD ��� PERMIT NOT VALID WITHOUT A' <br /> CONTROL NUMBER. <br /> CALL (209) 937-8386 TO REQUEST A CONTROL <br /> NUMBER NO LESS THAN 24 HOURS, BUT NOT IN <br /> EXCESS OF 72 e CONTROL#HOURS�RIOR�T START 0FrWORK. <br /> Show sketch above or refer to drawin aubmittad / <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, <br /> Standards and Specifications currently in effect, and to pay to the City its actual cost for removal and proper replacement of any item which <br /> does not meet the above requirements. Failure to comply will be cause for revocation of this 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 /> occurring 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 City Risk <br /> Manager prior to issuance of this permit. <br /> IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE OF A CONTROL NUMBER,THE CONTROL NUMBER WILL <br /> BECOME INVALID AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. (FOR CAPITAL IMPROVEMENT PROJECTS OR <br /> SUBDIVISION IMPROVEMENTS,PERMITTEE SHALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT(209)937.8411 FOR SPECIFIC <br /> INSTRUCTIONS PRIOR TO THE BEGINNING OF ANY WORK.)PRIOR TO ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE <br /> SIDE OF THIS PERMIT,PERMITTEE SHALL CALL(209)937.8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. l <br /> Signed: Phone: , i* 1s'1" GCS <br /> 1s'-Permittee (white) 2nd-Inspection (pink) 3r1-File (yellow) 411-Finance (white) <br />
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