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MAY-03-1996 11:31 _PUBLIC WORKS PERMIT CENTR 209 937 8901 P.02 <br /> 63483 <br /> CITY OF SfaCMIld <br /> dEPARTMENT OF PUBLIC W6AKS <br /> A00LICAtION FOR tidCl#dACHMA9611 ON PUBUC RIGHT-OE-WAY <br /> !z S _ <br /> A Ilcent' t!{ { Date.. ; <br /> A&M,M-, 1r Phvn � <br /> APPRUVED: Pueuc vvdiklics 6MECTOR <br /> Lacatlpn of Proposed Work,sic <br /> Owne t`gnl Addr6lS Sim t 't5 ASd✓ _ y n <br /> nh_�pmplailon Date Permit Expiration Dated <br /> j$dmeted Stgrtinq date <br /> I {or We) hereby apply for ars encroalcEifrs rrrlA to carry out the following work: —._. _...- AA) ` <br /> The ebmm named fiolieard hereby rvtgreln Mmiselen to- PERMIT FEE.....................3.- An47—. <br /> Ad&iAnal Footage Fee............ — <br /> Sewer TO Deposit............ .... <br /> Tpr-AL OEPOS1T__....:.. ..-- <br /> / Building Permit No. _ <br /> I�V" improvement Plan No. ---AZ 1 <br /> Supplemental Conditions: <br /> . . ., _, .t�' �r �j Arm• P��Z lrt� . <br /> Stow sioee:h afore or mrer to deewing yubmitted , <br /> IMPORTANT:Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances,resolutions, <br /> standards and specifications currently in effect,and to pay to City fts actual cost for ismoval and proper replacement of any item which <br /> does not moot above requirements. Failure to comply will be cause for revocation of permit- Applicant agrees t6 indemnify and hold <br /> the City harmless against any and all losses,costs,or damages resulting 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 <br /> City Risk Manager prior to beginhing c5nstruction.' <br /> PERMITTEE SHALT.CONTACT UNDERGROUND SERVICE ALERT(1-800-842-2444)TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL(209)937-841124 HOURS PRIOR TO START OF WORK FOR A CONTROL HUM13ER AND TO SCHEDULE <br /> INSPECTION- <br /> Read General Provisions on reverse side of this permi before signs g — No requirement of notifications and inspections. <br /> tat—Permiltee 2nd—F1h -'r 9rd—Finance nth—UnIHyl Slmcl <br /> TOTAL P.02 <br />