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Cid <br /> CITY OF STDEPARTOCKTRT <br /> KS MENT 7 6 0 0 5 <br /> =15 <br /> APPLICATION ON <br /> FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> %��_ <br /> Applicant's Name ARGILS—US SnG. Date v 1? I2 APPROVED: BY THEfN7e� � Vp9g1Eg DIRECTOR <br /> (Owner/is Na c e 1 <br /> Address 2000 ri�wP/,l S->fe X00 Phone S/0.652-45do Subject to the General Provisions and Special Conditions, <br /> and ail work must conform to the project's approved Storm <br /> City �Mer4Yi nG State Gtl Zip 2t160,9Water Pollution Prevention Plan or the most current version <br /> Location of Proposed Work, etc. of the City of Stockton Storm Water Pollution Prevention <br /> Mainte nce Staff Guide,whichever is applicable. <br /> an 8� Y&M arivt ir�ercec'fion &ct ScAug <br /> Owner/Contractor Address By Date /O+ /7 Z- <br /> Estimated Starting Date 70-- 22-L-,7 Completion Date Z Permit Expiration Date /7_ <br /> I (or We) hereby apply for an Encroachment Permit to carry out the following work: <br /> Z)rill a.,d =Ns c / 4y, ml o-F y qvt, dA � ,tV.,��.�,ta Deus ,. <br /> IM Otk t tM a M -�2•�n e7 ^' 140 �-7� .1•s o. oA i-Z- �qy <br /> : IAlvrr s .� r�r++e >�bn aefivt {ret �vr <br /> �� Lfnce/n Center Sr T.� -�ecl .-F <br /> ?7"t01114 I /mer efU,1644 e5cna: TL Roord <br /> ATTENTION:Applicant/Contractor-you are responsible to $ �� o <br /> replace all broken, damaged, and/or raised sidewalk, curb and PERMIT FEE............. <br /> gutter from score mark to score mark adjacent to the parcel; <br /> • g Z j <br /> remove USA markings upon completion of the permitted work. Additional Footage Fee_......... $ 3 <br /> The above nematl applicant hereby request¢pem,ission to i'9 ['C <br /> Sewer Tap Deposit.................. $ <br /> TOTAL DEPOSIT ...... $ 51?� <br /> 9 <br /> Sugdiag Permit No. <br /> Improvement Plan No. <br /> Stipplelnit <br /> ' V�y KOUT A <br /> L tO NTRUL NUMSER. <br /> CALL (209) 937.8386 TO REQUEST A CONTROL <br /> NUMBER NO LESS THAN 24 HOURS, <br /> CONTROLS BUT NOT IN <br /> EXCESS OF 72 HOURS PRIOR TO START Of NpiK <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,reso)ullons, <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)937.8411 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)9374381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. �r-� <br /> Signed: .c /��r-gam Phone: 510'��`' uSt;ib <br /> 1s!-Permittee(white) 2nd-Inspection(pink) 31d_File(yellow) 411-Finance(white) <br />