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FROM GETTLGR-RYAN INC PHONE NO 916 631 1317 Oct 24 2000 11 14AM P2 <br /> 0 6 <br /> CITY OF STOCKTON <br /> OOOA 13EPARTMEN3 OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Appheant 5 Name _ F� LN -� �-� Date <br /> [O nrerrlra to n - Q 13 <br /> Address bb t i Phonc'Llb� <br /> yir <br /> 1 _ APPROVED. pUBLIG WORKS DIRECTOR <br /> Location of P oposed Work MC J r1 __ U I e 1'n 'J- M="x-x11- <br /> ��._ ,,.p S�.-���► a til S k��.�'S?- <br /> Owner/Contractor Address <br /> la�3 CamplClton oate ____ d t 'O rmit Exptrat on dale <br /> Estimated Surfing 0= _ 'T <br /> 1 (or We) h by apply for an roachrpent it to arry out follov ng work pJ <br /> Tne�,r named%pplitanr no�soy*z9� <br /> est%oermissan to PEAMIT FEE <br /> Additional Footage Fee - <br /> Sewer Tap Deposit <br /> TOTAL DEPOSIT S� <br /> Suilding Permit No �- <br /> g l Improvement Pian No <br /> A Su plementaf ondttio <br /> C ICS 'a, c` } Aqua <br /> Show lk9teh abo"or refer to CrIN•,n Subm-'=rrt <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 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 tosses,costs, or damages resulting from injuryto persons,death of person or damage to property <br /> o"vring 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 beginning constructton &4-Z. <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-800-x'4+22444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES <br /> PERMITTEE SHALL CALL(209)937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION <br /> Read General Provisions on reverse side of this par b fore i t — Note requirement of notifications and Inspections <br /> isl—pnrmiiirr ZnC�Ftlp !C -Fuianac 4i�—Wiltyl$IOCt <br />