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CITY OF STOCKTON `J - <br /> PUBIACINCIRIM DEPARTMENT 77138 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> 7-Etevtn,r4v-4v CA> <br /> Applicant's Name 5+"ke,eyhw hM 5Wras,Ltd. Date 0311q t04 APPROVED. BY THE awatte'iti/'OM DIRECTOR <br /> (Owner/Contractor) p D",_6 (Akbe <br /> Address $017 l(1140ex-Poad SUAC i110 Phone i'L"W 4/-X; Subject to the General Provisions and Special Conditions, <br /> —a- i and all work must conform to the project's approved Storm <br /> City I?ancho � Mom State eA Zip Cir l-7 Water Pollution Prevention Plan or the most current version <br /> Location of Proposed Work, etc. 46ec66 Al.Pt466 � �Q� Maintenance Staff Guide, whichever is applicable.of the City of Stockton Storm Water Pollution Prevention <br /> -Ek►�c„oha3�f-450/V. P.c ,►� Svc <br /> Owner/Contractor Address 5--c '��''1 By. lvi(w� W 4b Date 4--1*-1L( <br /> -1 <br /> E - <br /> stim% Starting�[�e-_4&& _ Completion Date8t�a4E 07�dY//51 Permit Expiration Date <br /> I (or We) hereby apply for an Encroachment Permit to carry out the following work: <br /> Gctnc Cl06tc42t at KW-y /pC�flin 64 3 9V41!t,k 4 age 2 Me// ,Z2cs&4C 4�r�r, <br /> (ioel *YOUhk. Pzl 9Z14) <br /> ATTENTION:Applicant/Contractor—you are responsible to ,L rt ^o <br /> replace all broken, damaged, and/or raised sidewalk, curb and PERMIT FEE........................... $ > V <br /> gutter from score mark to score mark adjacent to the parcel; <br /> remove USA markings upon completion of the permitted work. 3�rf$ 23 <br /> The above named applicant hereby requests permission to: i[ <br /> 4��.�..s $ l Q li <br /> TOTAL DEPOSIT ...... $ 1 !i <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> CALL (209) 937-87-5 TO REQU`7 A CO.MOL <br /> P3U MDER NO LE:5 rTHAJt 24 KJJV3, DDT VOT IN <br /> EXCESS OF 721 HOURS PRION TC STAR'Cir W 3 <br /> l�l�dV 0 d�,C�1- <br /> Show sketch above o refer to drawing submitt <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 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 indemnity 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)937-8361. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. <br /> Signe Phone: 7 f�i-3��-o7as� <br /> 1s'-Permittee(white) 2nd-Inspection (pink) 3rd File(yellow} 4 l-Finance(white) <br />