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FROM GETTLER–RYAN INC PHONE NO 916 631 1317 Oct 24 2000 11 14AM P2 <br /> • CITY OF STOCKTON L1 Irk <br /> UEPARTMENT OF PUBLIC WORKS <br /> A& APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-IAF-WAY <br /> Applrcers ato lini s Name �.J�*``� ] <br /> Address M _ %r%- _.._. Date D v <br /> llr �2L-10 <br /> AddrSf 6 o �i Phonc'il�_� <br /> � � �`�I APPROVED PUBLIC WORKS QIREC'1nR <br /> Location of Proposed Work etc I{ �11LL11I <br /> Owner/Contractor Address y _. Date 's-��i! <br /> Estimated starting Date f�r3 compictton Date 1 IO rmu expiration Date _ <br /> i (or We) h eby apply for an ncroach T ent it to carry Lit the follo'''f ng work fir _ <br /> The abo c named applicant hor0y requests permission to PERMIT FEE $ � <br /> Additional Footage Fee <br /> Sewer Tap Deposit <br /> TO"i'k1.DEPOSIT <br /> ' Building Permit No <br /> 6 Improvement Plan No _ <br /> t <br /> Supplemental . onditio <br /> (,ck,��s w � ` 1c,k <br /> 2� hut eb �tIcs 'care <br /> Show 8ke1Ch above or rear to Drawing sub ."' <br /> IMPORTANT Applicant hereby agrees to comply with all prow+sions of this permit as well as all applicable City ordinances, resolutions <br /> standards and specifications currently In effect, and to pay to City its actual cost for removal and proper replacement of any Item which <br /> does not meet above requirements Failure to comply will be cause for revocation of 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 /> occuring at the site of or as a result of work to be performed under this permit A certificate of Insurance shalt be submitted to the <br /> City Risk Manager prior to beginning construction ((pA�- <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-800-'8�i.22444) TWO WORKING DAYS BEFORE BEGINNING <br /> 0 WORK FOR LOCATION OF UNDERGROUND UTILITIES <br /> PERMITTEE SHALL CALL(208)937-841124 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION <br /> Read General Provisions on reverse side of this =V� <br /> — Note requirement of notifications and inspections <br /> 3'pneo _- - I '7r6-631- 1362> <br /> I-i—Perrnrurr Znq—Filo drd -Finance slh—{Jtuiiy/9VOet <br />