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64986 <br /> M <br /> Mj CITY OF STOCKTON <br /> 1 DEPARTMENT OF PUBLIC WORKS <br /> APPU ICATION FOR ENCROACHMENT ON DUBUC RIGHT-OF-WAY <br /> cv�1 A4 " <br /> ApppGnrtt'a Name - <br /> (QNrrMr!ContrACt _ <br /> �A <br /> Phone o a- o <br /> APPROVED: PUBLIC WOFACS DIRECTOR <br /> t-4r,otion at Proposed Work,etc/'� �-��✓�-. <br /> QwrVBflCOniraCtar AntltCs! YpL�___. .._. . - — '_ Onto c �v <br /> Estimated Starting Data -zg, Com0r5b4n Oste r _ Parma ExpiriUon Det& S !s --- <br /> I (or We) hereby apply for an encroachment permit to carry out the following work <br /> 10C <br /> I <br /> (AT�,J 1Lc. <br /> TM•oove name0 am cant nrrrby rcquatu permna,on to- PERMIT FEE - - S----- �7•�-7 <br /> A60gtonsl Foatage Fee <br /> SwA*rTap Dep=it -------------- --- ¢, <br /> TOTAL DEPOSIT ...... 5_-- --- t2e <br /> Building Permit No. <br /> Improvement Pian No. <br /> Supplemental Conditions: <br /> tAexK s+s v t<S <br /> 0�:00 I-RN -z 3'�oa f-,- Mzlt+t r - <br /> v:V-k>Jo-T <br /> �D *<J tOetC �t uAwt kA <br /> 1�tCn•t dr c*"+' - rn w0 �aA>yC�l. tl �cb <br /> (At-e <br /> Snow skctcn abuve or reW to ar6win0 a,mmmao <br /> IMPORTANT:Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, resolutions-';D <br /> standards and specifications currently in effect,and to pay to City its actual cost for removat and proper replacement of any item which 6"0?. <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 shall be submitted to the <br /> City Risk Manager prior to beginning construction. 60Z <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-800-42-2444)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 perm efore Ig ing — Note requirement of notifications and inspections. <br /> tat—rormtttae 2nd Rv 3rC—rinanra ash -uhAtyrStrart <br /> Z -d 81I1, L9V 60Z WNOaIAN3030 030NVAGV W08A WVLV=L 8661-8Z-7 <br />