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rCITY OF EkROACHMENT PERM Permit Number <br /> -a STOCKTON ON PUBLIC RIGHT-OF-WAY AP/9 dAPL� <br /> Applicant: utr r` \'1C��I1raf1 IlAe.� '1�� <br /> �c 11 e; r'I APPROVED: BY THE DEPARTMENT DIRECTOR <br /> { 'j v� J <br /> p `� l z Subject to the General Provisions and Special Conditions, and all work must <br /> Address: <br /> V J-' SkG� 2,, �A conform to the project's approved Storm Water Pollution Prevention Plan o <br /> vwi the most current version of the City of Stockton Storm Water <br /> t Z) Pollution Prevention enance ff Guide,which ver is a <br /> City: �`�\��i\`r�CbIV� State: _ C }' ZIP: l� Q applicable. <br /> ip- / <br /> Phone: e;UT_-_ -7-16000 E-mail:4Vill"Vtt*,egdV�p� � LL By. � Date: 6? <br /> � — J <br /> ssociated Permit(s): Expiration: <br /> �` ^2121 2t�3 �, -y <br /> WORK LOCATION: ✓1 'CYb/�� t7C D.G�[(Ut su S <br /> tart Date: e�� CAU t, f 4_1 <br /> I q Completion Date: ,( �r p 5f 2e ( rx <br /> ^. �, <br /> a n.1...yi.� �rd'iy j �Yvl 9 95 <br /> i E S f" d ;'t 4-'Sti�i i 4�i'6J S'DA i' Lo-F A iU(. <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the w ,momma a <br /> parcel;remove USA markings upon completion of the permitted work. <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> InSkII +W0 f?1 �� d�. y M0y1i4Df kr 14{ 11.S +D A dtDA o <br /> be to, crudt Vslk c k0110,A) 64yr Quccrs <br /> Show sketch or refer to attached Drawing Official Use Only <br /> Base Permit Fee $ e-2-3 , <br /> Additional Footage Fee $ <br /> Misc. C" f—E=E $ <br /> Misc. 7Z" Ff:7'E $ Z3 <br /> Misc. $ <br /> Total $ <br /> Special <br /> Conditions: <br /> - <br /> 01 - 12_LZ <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, Standards and <br /> Specifications currently in effect, and to pay to the City its actual cost for removal and proper replacement of any item which does not meet the above <br /> requirements. Failure to comply will be cause for revocation of this permit. Applicant agrees to indemnify and hold the City harmless against any and <br /> all losses, costs, or damages resulting from injury to persons, death of person or damage to property occurring at the site of, or as a result of, work to be <br /> performed under this permit.A certificate of insurance shall be on file with the City Risk Manager prior to issuance of this permit. <br /> IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE <br /> OF A CONTROL NUMBER, THE CONTROL NUMBER WILL BECOME INVALID <br /> AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. PRIOR TO <br /> ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE SIDE OF THIS Sign <br /> PERMIT,PERMITTEE SHALL CALL INSPECTIONS AT(209)937 8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br /> SIGNING. Print a li c, <br />