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a • CITY Of STOCKTON . <br /> 0EPAIRTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON Pt,I9LIC 1111010 F.WAY <br /> N2 61619 <br /> 44 <br /> filwe-tiractw) <br /> aa <br /> Addtas P1�on <br /> umflon of Propo"d work,etc _ ! ,_li? tNa APPROVED. DIRECTOR OF pNSLrC WORD <br /> owtwwenl.ewer .u �Y. 7�!S� .� f. "i� WE 7 ey Auto ^" <br /> Estlmeted Stoning Qehr completion Dat Perndt Expiration Date asd i <br /> I (or We hereby apply for an encroachment permit to carry out the following work. <br /> d Ims-G r <br /> i <br /> I <br /> Ito obrw named applicant herby requests parmiaksn to PUNT FEE... ....... <br /> 4001A699," ,fh*//04r f*'a4 14&4� f41I'dtf/ A! <br /> � r Additional i:ooteQe PN.... ...... ........ . <br /> YOTAL DEPOSIT <br /> Building Permit No. , <br /> Improvement Plan No, <br /> ( <br /> 'Supplemental Conditions, <br /> see A#4ekd 0�,Wwl rtj <br /> Shaw sketch above or►der la drawing submitted <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all opplit1ble City ordinances, <br /> resolutions, standards and speeifieotion: currently in effect, and to pay to City its actual cost for removall and proper-replcice- <br /> ment of any item which does not most above requirements. Failure to comply will be cause for revocati n of permit, Appli- <br /> cant agrees to indemnify and hold the City harmless agolnat any and all losses, costs, or damages resulting from injury to <br /> persons, death of person or damage to property occurring at the site of or as a result of work to be performed under this <br /> 0armit. Certificate of Insurance will be presented by applicant upon request, <br /> Read General Provisions on rdvanse side of this permit before signing. Note requirement of notifioations A Md Inspections. <br /> Permit Enginearl Inspector <br /> 944-8260 4 <br /> 9448389 Signed r "Phon� <br /> 2nd-4:11@ 3rd—Finance 4th—utility/street <br /> #; *EEZiil99O194 wyez:06 : 36--OL-8 OZOL Js!do381011 x0aeX:A9 lNH <br />