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P Permit Number <br /> ENCROACHMENT <br /> CITY OF IVEU m714 —o <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY �► 1 <br /> // 1 a <br /> Applicant:. r�:�z �A� U S. ' - } AIA,/PPPROVED:BY THE DEPARTMENT DIRECTOR <br /> YI C Date: 7 �� J XKVI e®�i1 TiM5 <br /> - 2 u6je Hfi4h'fRpecial Conditions,and all work must <br /> p <br /> O conform tdRI5PMFV"a8Storm Water Pollution Prevention Plan o <br /> Address: LLJ <br /> ot99 I �� � �G� S , ki ..,S� Ln the most current version of the City of Stockton Storm� Water <br /> ,t�t/� I [� �} J Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> 1 <br /> City: i� 4 ei �( 'l�( � state: ZIP: f n7 a <br /> _ t' a . <br /> �iiF1'AG�V1U Date: <br /> Phone: E-mail: 0 <br /> O <br /> [Associated Permit(s): Expiration: J A <br /> WORK LOCATION: I �EL� r(�- AV L, J��f��tc �A <br /> vy/3v/(� jj� Z P v D 'AUD AVITBOUTA <br /> Start Date: Completion Date: ��/�C} �� <br /> (;0'1 1 i�.0 N MM"BER. <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, CAL ��_�'��% W7 4 -85 I O REQUEST A CWROL <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the t&! ' . (jn 24 HOURS, BUT NOT IN <br /> Parcel;remove USA markings upon completion of the permitted work. Ft.ci-=3S 01-72 iOURG PRIOR TO START OF WOK <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> Q�St� Dov (1 wr' 1� (Mtn' -/S� �nor.e-rt �1�f Tate ��s Shop ;t2 1G ;(s <br /> 4 -%! / 4,V ®re5SU1P <br /> Show sketch or refer to attached Drawing <br /> Official Use Only <br /> C>e2 �t1 -h�n� `r f"�Pfa41 Lt �j f�n 'R <br /> J � Base Permit Fee $ <br /> 1V4.4— rj9r' ©f vie-11 ih �ke- Additional Footage Fee $ <br /> EL !/ter�i�P^ .�� .�-f. Misc.I�t '��'+o(fl�-y $ 3 p� <br /> /�— <br /> `��'L���Q ��f'I/r1 SLi,ot✓ ?/'L 4-!'l Misc. _ 1 LAS $ �( •�� <br /> Misc. $ <br /> 'fF0Ai�--, �`� ���' -'-P"� ' Total $ 573, <br /> Special Conditions: <br /> lz `aS"ehP' o it <br /> M1 � , S-t- A- <br /> V;� OPn*l r► )'Or -1D CJ1 1' Of WC - <br /> nor in gFez+Ik)Iiq <br /> Z-f iw4PaC+'13 Ks ' S*F, d0V1+&Z+ VV0*0el1 IKrCll Ender a, 2oq-b - ��644Vt- <br /> IMPORTANT: <br /> 2Tb) -b orilu-I VtJPCafe_ bus 5)ap 2077 JC57 5 �a,ll 2 ho�,rJ pnbir-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 J <br />