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t NAM. -23` 94(PED) 16.3$ P. 002 <br /> CITY OF STOCKTON <br /> • ", <br /> DEPARTMENT OF PUSUC W04KS ' <br /> APPt.lCATION FOR ENCROACHMENT ON P.UR IC MONT-OrdNAY <br /> N! 62322. <br /> .r 7 O r �w moa <br /> MIDn <br /> le�oarnn of P"VMiW ark,a " APPROVED DiRECTCR OF lskldlf C VIMKS <br /> airrYr- on Add-op, <br /> ��dled A Sy <br /> Sart' ^Rler�mr i <br /> _ it Fatp��ation bvl <br /> I Por We) hereby apply for an encroachment permit to carry out the faLlowing wor - Aguer+ <br /> -f—P, I t <br /> VIA— <br /> Pw 06we all aPPIT-nit hereby mquam penrr&dw b. PERMI7 FFA.-..--------- S d to <br /> AdditkWiol Fd6tape Fee... <br /> SewrrTnpCM+voail _.:w--- .._ 1 <br /> iz <br /> TOTAL DEMNT .._ ......... L O <br /> Building Permit No. ._ <br /> Improvement .Plan 'No_ <br /> Supplemental Conditions= <br /> 56nw skeieh ohpve or rebr to drawing eubn:ried <br /> IMPORTANT. Applitnot hereby agreas to comply with all.provisions of this permit as W611 as all appliat le City ordinances, <br /> resolutions, standards and specificWions currently in effect, and to pay to City its actual cost for removal and proper reprace" <br /> trent of any item which dares not meet above requirements. Failure to earr,-pfy will be cause for r+errocotion of permit: Appli- <br /> cant ogrees to indemnify and hold rhe City harmless against any and all losses, 'costs, or damages resulting from Ihlury to <br /> persons, devth of person or domoge to property occurring of ft site of or as o"result of work.to be performed under this <br /> fternut_ Cwtificnte of insurance will be presented 6y_applicanT upon request_ <br /> fleet General PnnIp oris an ramaisa sada of this permit befars signing. 'Nota retrylremenl of notlamilons and Irmpwthans. <br /> Perndt Englo"Tll"Pector <br /> 24 <br /> lar--veraunae 2nd—Fisr- 3rd Finance ,th—Utirrey/sneer. <br /> f <br />