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.ir11`1-14-1999 1525 •9LIC WORKS PERrAT CENTR • 209 937 8901 P.02 <br /> 4 <br /> CITY OF STOCKTON 64899 <br /> V1100, <br /> DEPARTMENT OF PUBLIC WORKS <br /> p,�/� APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> ApOlicant's Name-lp( ^�T � �j,�t!6,rp/ex�j-- Oa10 Aa–.— <br /> &0/0 <br /> a..._ <br /> (Owner/(•gnlraclDr S/O��R.?-r,rC• _ <br /> Address ��OO�yI[xy.,//syr /.2 frt e�•nv Ji/CPhonCsO'� =Y•Sa0 <br /> C`.i7.�Ybo <br /> laopon of Proposed Work, etc V J APPROVED: PUBLIC WORKS DIRECTOR <br /> �I'tq-- . ..._ .. ...._ <br /> OwnerrConvanor Address SCe_.�?—' <br /> Estimated Starting Dale //c/�Q?— _Compinllon Oala //10/ Permit Expiration Dale ,r <br /> (or We) hereby apply to <br /> —rZ encroachment permit to carry out the following work : <br /> `''� •—a-� i�._r_ p i yam' <br /> orti..'L._-arc <br /> Ca✓nv�- �' V .1� �wor_, S.�?t,�}-.� C �dS MW_)1 <br /> The anm."-Id apolkLil hereby roque,Db,nin:ion to —PERMIT FEE. ............... E t7(� <br /> Andlhonal Footage Fee. .. <br /> Sewer Tap Deposit . <br /> 4oc, K 3 TOTAL DEPOSIT.. S QQ_ <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> l.l�El.l_ Slir�1.� pz. nLr>,C.CC� <br /> W t1'ltttll '�laE . t'f�tZlCth'L-+ LiL,iE . <br /> Shnw.xelch soP s w we,to d,gwiny cubmiltpe <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. Piailure 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 properly <br /> occuring 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 construction. Z <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1-800,812-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGUROUND UTILITIES. <br /> -PERMITTEE SHALL CALL(209)937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> 'ECTION. <br /> Read Geneml Provisions on reverse side of this permit before signing - Note requirement of notifications and inspections. <br /> rne, O 6V <br /> el .vn,mnln• 2m rlr Nd rio.,r, eh tllailvr Sbenl <br />