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• Permit Number <br /> CITY OF ENCROACHMENT PERMIT EFP14 _o <br /> -7A <br /> m5STOCKTON ON PUBLIC RIGHT-OF-WAY <br /> %! } APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant: !''_ t 1 L Date: >/ z Subject to the General Provisions and Special Conditions,and all work must <br /> 0 conform to the project's approved Storm Water Pollution Prevention Pian or <br /> Address: a99q (J l`%1.. �Lf P C`� Ln the most current version of the City of Stockton Storm Water <br /> L �- Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: L� /L.i 1 ,�fCC�� State: _ZIP: �6 v /�� 3 / <br /> k �rS0 '41�.6 L, BY; A/tKV— t./P'�'A�t�1Q Date: 23 <br /> a�- W.T-�613 - <br /> Phone: E-mail: p � <br /> LL- <br /> [Associated Permit(s): Expiration: <br /> WORK LOCATION: 1-1 <br /> V � ` Ay,�,-5,toekl-tor �A <br /> Start Date: (��( 3Z.�/r�" Completion Date: ��/3C;��� � '�`t� �•���VALID ��f�'���a <br /> C <br /> N 6yR i rS <br /> ATTENTION:Applicant/Contractor-you are respons'ble to replace all broken,damaged, Lr.(L fwtu,'."j Cj37M+ TO REQUEST A C}NMOM <br /> IN <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the t� )@i?3f. flit SS + 1 2 KURSBUT «7 <br /> parcel;remove USA markings upon completion of the permitted work. fiOURS PRIOR M START OF WORK. <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> Show sketch or refer to attached Drawing <br /> / Official Use Only <br /> /f Base Permit Fee $ <br /> 1G,a,+roen of" /tA ��j we-41 in •f ke / Additional Footage Fee $ <br /> ,111 f O C L.w* 6WI ` �—r� � - " _ �� Misc. rolo y 2z J�%�G $ 39 , 2 <br /> , 2 <br /> R-ir 1�C <br /> f't( � ' F'►-91 s:-ILO Misc. y <br /> Misc. $ <br /> F y e--. �`E���11f- Total <br /> $ <br /> Special Conditions: <br /> —AoA4 q��µ p L r i -,' - o— <br /> Rj -,s �'i/� �y,c,� Com►c�FD1N{u I.e,!/ , -f"��C-rr`"�'y' Q� <br /> r 7 <br /> f s . �t41 WI S�P�U�'lbv+t CA.� �A Fon <br /> �w�pac�t�in9 ks, sip. Go►�IFrir t' W�Ie,ZI 4Gr�� L KCIet- <br /> �.�rV) r+v l v�loCa,k- bus 9bp 2-fq- iV5 � , cml1 --7z ho�J pr,bt - S�-f' <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 />