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MAR 13 '98 14:29 FR LEVINE—FRICKE—RECON 51 ...I, , ... 6421 <br /> 421 I .I <br /> - CITY OF ST13CKTON • /�G <br /> DEPARTMENT OF PUBLIC WORKS <br /> p CATION FORFIN PUBLIC RIGHT-OF-WAY <br /> 1Li a � _ D� <br /> APOIF;iM s Namp �y`a <br /> IOwnprr CPnlraer rl� PnenA�10 �.� 3 pIRECit7R <br /> Pdaress—. 1- ` APPROVED: PUBLIC WORK <br /> LpiRion Or Proposed Wotrk.arc. 'l� ,s� -. ^S/t3 <br /> 1}t��r � �M9.tiWyyOyb�l1— �r C� (.�� Er D (,�'�Dara .• <br /> pwnarr:enlracSer Address _Nt� pp1'— �^ - 2 Q 1 <br /> �u tU CampKeorOele _J (� `� Pcrmi Fxo�raran DaY -�.- 9_l--�L�- <br /> En mewl SMnm9 Dere - <br /> I (or We) hereby ap'ppI for an encroa.chment Permit to carry out the following work - r <br /> ALR _ 'G�_RSTnnB]ny�< _' --_ •-- <br /> PERMIT FEE <br /> im aea­"anN pppiira"�naeOl rsgyase parTsup"m <br /> Addilie^e�FdnMge Fee <br /> $ewer T9a DaCes�� <br /> Sj,l��n I Auo Ir/J` 'J TOrAr oevoSIT <br /> Building Permit NO. <br /> Improvement Plan No. -- -- <br /> Supplemental COndllions: <br /> t. II F1yfu2 7r7 6 - 3d 4^'t <br /> OP 41c"Zg 4 py"i /YL1�ll7FT <br /> Shw WWI poo-•a•Mer a cra�me:ua+uKe <br /> well as all applicable City ordinances. resolutions <br /> IMPORTANT:Applicant hereby agrees 10 comply with all provisions 01'his permit as <br /> standards and specifications currently in elfect,and to pay to City its actual cost lot remo(il and proper replaceagreesment <br /> t at any tern <br /> indemnify and hold <br /> does not meet above requdements, ch <br /> Failure to comply will be cause for from In on o fpa de <br /> the City harmless agdinsl any and all losses, :0515,or damages resulting from mlury t0 persons.death OI person yr damage to propertythe <br /> Oceuring a1 the Site 01 Or as a result Of work t0 be performed under this permit A certificate Of insurance Shall be submdted l0 the <br /> City Risk Manager prior to beginning eonsiruction. <br /> PERMITTEE SMALL CONTACT UNDERGROUND SERVICE ALERT (1-800- -2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES <br /> PERMITTEE SMALL CALL(209)931-6411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions an reverse side o1 this P r it b 1rja sj4 gaining — No requlreminl of notificationsand 'r+sPecuons <br /> sa•a <br /> tl-pOrm.1Kt exp-�a• <br /> �m-r...n• un-uenKr Srea <br /> • , „,� 209 937 6901 PRGE.02 <br />