Laserfiche WebLink
`..� CITY OF STOCKTON 76753 <br /> ('9 .pU8WG-WAFtKS DEPARTMENT <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> M5 Applicant's Namewofi c�(/FUdl2(IN�lG� �I/I!(°f Date APPROVED: BY THE 141:118MG-WOR kS DIRECTOR <br /> (Owner/Contra'cSor) � Sub ect to the General Provisions and S ecial Conditions, <br /> Address- rNb►'cA o- *-5- Phone�lb w�-z/' I p <br /> and all work must conform to the project's approved Storm <br /> City a!u"o 41u State " Zip -t9-762 Water Pollution Prevention Plan or the most current version <br /> Location of Proposed Work, etc. 3qo e.M,ti ciT , ��t"DGl/ � of the City of Stockton Storm Water Pollution Prevention <br /> Maintenance Staff Guide,whichever is applicable. <br /> �a�^u�c-ry'cCf��YJ tv 8 K�/M!d <br /> � 5,4e xmm, ah�nCeorAs 9Zr8 (yD By W "" 0 " "Data <br /> Estimated Starting Date44"� Co,mpletion Z " <br /> Date Permit Expiration Date s �r <br /> I (or We) hereby apply for an Encroac N19 �e�m't,o�arry out the following work: �y5t4rt7 reg?4al�Sef� <br /> rOL(Lt[; sin,pi�Ctfv I' 9 ldc �S . f�+zta �f� L a.��r � 1�0 : <br /> ,acct^etsc.cc•�Y/ .yFcuc�cc �=r .�s�� 4 mil, Anz f� Ale. <br /> 7 A&716 <br /> ATTENTION:Applicant/Contractor-you are responsible to <br /> replace all broken,damaged, and/or raised sidewalk,curb and PERMIT FEE........................... $ , <br /> gutter from score mark to score mark adjacent to the parcel; , <br /> remove USA markings upon completion of the permitted work. (. $ ��/ <br /> -17 <br /> The above named applicant hereby requests permission to: CR S <br /> . $ <br /> �fl (�/_ <br /> -GeweF TM-13 ................ �C" `Fg <br /> 1 TOTAL DEPOSIT ...... $ b_ZZ / <br /> N&I z� <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> POWWTVAMUTMA <br /> COHMNUMM <br /> CALL (208) 937-M TO RE(MOT A COPIT1a0l <br /> MJME)ER NO LESS THAN 24 MMS, WT MDT 1W <br /> EXCESS OF 72 HOURS PRIOR TO START OF W06 L <br /> I <br /> Show sketch above or refer to drawing submitted <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 the City its actual cost for removal and proper replacement of any item which <br /> does not meet the above requirements. Failure to comply will be cause for revocation of this permit.Applicant agrees to 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 /> occurring 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 Risk <br /> Manager prior to issuance of this permit. <br /> IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE OF A CONTROL NUMBER,THE CONTROL NUMBER WILL <br /> BECOME INVALID AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER.(FOR CAPITAL IMPROVEMENT PROJECTS OR <br /> SUBDIVISION IMPROVEMENTS,PERMITTEE SHALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT(209)937-8411 FOR SPECIFIC <br /> INSTRUCTIONS PRIOR TO THE BEGINNING OF ANY WORK.)PRIOR TO ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE <br /> SIDE OF THIS PERMIT,PERMITTEE SHALL CALL(209)937-8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. <br /> Signed: (/ CCL/ L.1LlxAlti Phone:(7 <br /> Ind L.n.---i;__ Ord CL./....11—A Alh <br />