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ey 1 ( PUBLIC WORKS PERMIT CENTR 209 937 8981 P 01 <br /> if <br /> Cr"OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION O ENCROACHMENT ON PUBLIC RIGHT-OF-WAY 66090 <br /> 000AW <br /> s App Itcanrs Name ?o S E r ti R A M A f- IL Date 11 3 fJ b <br /> 4Oivrterr ntrec60rF c a N sv k T A t A Or F N ( 9 16) <br /> Address P- 0, 0 x 169 Phone 3S -L S o <br /> city RA tit t1 E�IE TAsate C A z1p 5 6$3 APPROVED- PUBLIC WORKS DIRECTOR <br /> L agon of Proposed work,etc S I d E W A t It AT <br /> 130 H- HVNTE R S STOOTO N q <br /> owned contra««Ark>rass F l SC 14 E W V I S 0 MAL L By Hare; 1 — Tca <br /> ' Estirt abng Stating Date I Z I 00cDate 1- 1 0 0 ennrt Emllation Date <br /> ' I(or We)hereby apply for an enroaehment permd to carry out the following work P R t t,L( Z) S O 1 L 13 0 Iz I N&S 'to <br /> GROVK WATER 35 FEET VEEP FOR SOIL AND C,'ROVNOWATER 5Ah U <br /> SOLI 6aPIN(rS WILLIE DRILLED VO 111A A QFQPRO4f, T14E 50RINC-S WILL <br /> BE ?- INCHES IN DIAMETER,— TREY WILL BE SEABED WITH NE6T U <br /> CAOVT LACED SY' TREMIE ON THE SAME PAY THAT THEY ARE QF%t1LFQ, <br /> THE COWL ETE SWRFACE 1NIll 5E RESTOREDBY FLYSATC}1 NO <br /> PERMANENT \NtLJJJRVCTVRtS WILL BE INS ACLU <br /> Cha above namod apgtcartl heroby reauene permkjwr-1c PERMIT FEE S �'✓ 00 <br /> S L"c A Z T A C H E D E 1 &V R E -L Additional Footage Fee $ <br /> el 5 11 ` PEA N -i Sawa(Tap Deposlr 1a <br /> TOTAL DEPOSIT 5 (Z P 00 <br /> Building Permit No <br /> ' Improvement Pian No <br /> Supplemental Conditions <br /> � �Tf p�Il Sic1t� ��Il fie. Q <br /> - e f Cas- at�iarL` `w� off, car as <br /> ' Show parch abv"e/Ater to Aro—IJ-h --ase- <br /> IMPORTANT Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, resolutions, <br /> ' standards and speefcabons currently in effect, and to pay to City its actual cost for removal and proper replacement of any mein which <br /> does not meet above requirements Failure to comply will be cause for revocation of permit Applicant agrees to Indemnify and hold the <br /> City harmless against any and all losses, costs, or damages msulang from injury to persons, death of person or damage to property <br /> occuring at the site of, or as a result of work to be performed under this permit A certificate of insurance shall be submitted to the City <br /> Risk Manager prior to beginning Construction <br /> PERMITTEE SHALL CONTACT UNOERGROUND SERVICE ALERT (1.800-642-2444} TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOA LOCATION OF UNDERGROUND UTILITIES <br /> PERMITTEE SHALL CALL(209)937-J411� HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> SEW,INSPECTION <br /> Read General Provisions on reverse side of this permit before signing - Note requirement of notifications and inspections <br /> s� <br /> P.. 911 35 -3Z 50 <br /> tu.Prmmse >!++d•i�ie 9-d Frlene! •th U1MyM&&1 <br /> ' TOTAL P 01 <br />