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low <br /> We <br /> -C) CITY OF STOCKTON I <br /> 2 3 3 i <br /> PUBLIC WORKS DEPARTMENT <br /> S COAPPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY , <br /> .0:P441 L(-I P.S Q�Q <br /> Applicant's Name SINTEC Co/JSULTt G Date".2 " APPROVED: BY THE PUBLIC WORKS DIRECTOR <br /> (Owner/Contrr2 ctor) 6 _ Q 1 <br /> Address W CO�l WA " Phone I16-5500-290Y Subject to the General Provisions and Special Conditions, <br /> n �,,,,,,�M nr1 and all work must conform to the project's approved Storm <br /> City �W aA LYJv t O State "7 Zi SBI Water Pollution Prevention Plan or the most current version <br /> Location of Proposed Work, etc. tr'� ' of the Cit of Stockton Storm Water Pollution Prevention <br /> t S Maintena a Staff Guide,whichev r is applicable. <br /> G�('oW W e M �re <br /> Owner/Contractor Addressm30)9 1C)1.(iol'� P-bIUlQ7, FM1�1 'O CD -B"y Date <br /> Estimated Starting Date D^ZS—OQ' Completion Date 10,71—or Permit Expiration Date <br /> I (or We) hereby appl for an Encroachment Permit to carry o the following wor `. l i� <br /> 1.r W <br /> all K-to� 4 <br /> -m <br /> ATTENTION:Applicant/Contractor—you are responsible to - 50 o- <br /> replace all broken, damaged, and/or raised sidewalk, curb and _PERMIT FEE...........................'a v <br /> gutter from score mark to score mark adjacent to the parcel; - ` - - <br /> remove USA markings upon completion of the permitted work. Additional Footage Fee'.......... $ <br /> The above named applicant hereby requests permission to <br /> Sewer Tap Deposit.... .... $ <br /> y <br /> TOTAL DEPOSIT .... $ �. <br /> (� <br /> Building Permit No. <br /> �pp�J Improvement Plan No. <br /> � C A /O Supplemental Conditions: <br /> ERMIT NOT VALID WHOUT A <br /> ONTROL NUMBER. <„ . <br /> ALL (209) 937-8388 TO REQUEST A CONTROL <br /> UMBER NO LESS THAN 24 HOURS, BUT NOT IN <br /> XCESS OF 72 HOURS,PRIOR TO START OF WORK. <br /> ONTROL# <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-Mll 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 /> , n3 ,v <br /> Signed: . v red t. ;ztePht7ne: 9lfi <br /> 1`: -Permittee (while) 210 -Inscfectinn ininO and_File r„our.,.n nm �:......,.,, r..,..u..a <br />