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Permit Number <br /> CITY OF <br /> ENCROACHMENT PERMIT <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY T <br /> Applicant:. /I FiAPPROVED:BY THE DEPARTMENT DIRECTOR <br /> / L�•� YI G. Date: <br /> L �,, l Z Subject to the General Provisions and Special Conditions,and all work must <br /> ag�q v t.l� �� .s' /P �LJ(J O conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: / vwi the most current version of the City of Stockton Storm Water <br /> b �} J Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: ,Jj2j4g:2 ! CfeL e State: _ZIP: l�5! • Q <br /> �J _ /�12 u 11/tOW (iJLI'ALI Date: 3/4 / <br /> Phone: E- <br /> mail:: LL <br /> O <br /> Associated Permit(s): Expiration: 1 <br /> WORKt-1-T L/-T f*d;� �� ;4 -e- /Jyj <br /> LOCATION: / 7y �El�ir cC- ��(Z, s"gr <br /> Start Date: (�`f I.3� Completion Date: n3CS/,�� r� <br /> c:01'}�C) Ela R- <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, C`' 'is yr j 937ZAI S I Q REC EST A CONTROL. <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the i'ri';`:i a'Z la o LF 38 "MIN 24 HIOURS, BuT NOT IN <br /> Parcel;remove USA markings upon completion of the permitted work. i72 P-01 RS FR14�TO START . <br /> �. <br /> I(or we)hereby applyfor an Encroachment Permit to carry <br /> /out the following work: 4-i(✓� <br /> , / / c <br /> 1 Ae- btl S�b� I CZ /lilt% � <br /> Ave— 4\r <br /> Show sketch or refer to attached Drawing <br /> Official Use Only <br /> h fJ / j 7 Base Permit Fee $ S <br /> L.-4-+roh ©� �Lt .✓ 1 vie-11 jh t4e- Additional Footage Fee $ <br /> ��'1L-�.O�C:�L C.�✓L l ems. <br /> $ 3 <br /> Misc. h $ T <br /> 5Z�� Alu- <br /> Misc. $ / <br /> i c , �`>: ►.2�P�`'`'P-� Total <br /> Special Conditions: <br /> -�►-utc��f/ lw hiz,+or M95i- call <br /> f' 204 - 437-63" -b 91- A- <br /> Zf ►w►pac in9 Ks sip, Ge t- We,►�le,�l �I I twcLoe a. 209 -b - z, <br /> -mow+ o►�t,-I v�lc�a�� O+s Sficp 201-Jvs S1 , call `2 howyj �- <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)937.8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br /> SIGNING. Print �'— <br />