Laserfiche WebLink
r <br /> JUN 09 194 16:28 GEMUDIT 084 P02 <br /> s CITY OF 51OCKTON %Wo <br /> or, DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENMACHMINT ON PUBIIX Rl*1J1r-0I:WAy <br /> F N' 62670 <br /> /iodimrrr's hle�d� �t►at <br /> �Rddref Phone '2� <br /> Lwation of PrapaNd Work.era Air APPRQYED: DIRECTOR OF PUBLIC WORKS <br /> —� <br /> a.rmIee�eracwr ey fail <br /> Cwfimeled Slartinp do Cwnplesiort Gare permit Et rr <br /> P a#ion pa <br /> I for Vile} hereby a ply far an encroachment permit to carry out the following work- <br /> The obv,ro runwd opphtato hariby requests permission to- PERMIT FEF__............ � <br /> Addnlatw 91�mivw Fee---. .... ... .. <br /> Sewer Fop aep"it..................-.... <br /> TOTAL D£P0517 ---.'........'-.-------- ! <br /> Building Permit No. <br /> improvement Plan No. <br /> Supplemental Condttions: <br /> 24 HMIRS PMT0 SM OF <br /> PfltlYlFl�Si#llti.q!!gT�ilk <br /> WDIRX FIX A CONTNX MUM <br /> AND <br /> TD 5'gllEplll:E 1p3MM <br /> Shaw skaah above or refer to drawing sub mi"ad <br /> IMPORTANT: Applicant hereby agrees to comply with oil provisions of this permit as well cis all cpplfcable City ordinances, <br /> resolutions, standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replace• <br /> meat of any item whlch does not mace above requirements. Failure to comply will be cause for reMocation of permit. Appli. <br /> cant agrees to indernnify and hold the City harmless against any and ail lasses, costs, or damages reswIfing from injury to <br /> persons, death of person or damage to property occurring at the site of or cis a resutt of work to be performed under this <br /> permit Ct rtifimfe of insurance will be presented by applicant upon request. <br /> Read Upmral pmosians,an rdversa side of this permit before aigrting. •Nato requirwneat of notifications and Inspeationa. <br /> Permit Enpinesrllft"eetor <br /> 944.8260 <br /> 944-83U cap Phone <br /> + l :F_�lpi,E- kt 937-9411 <br /> 1ss—►eimltrw 2rd—Fiie 3r�Fnanco stl�utii,trlslreef ; :r '` :RIIA TO START OF <br /> j r.;,,t A CONTROL NUMBER <br /> AND <br /> �0 SCNE:D4,LE INSPECTION <br />