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CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Appimun 55763 <br /> /z <br /> Location of Propawd Work,air.. APPROVED: DIRECTOR OF PUBLIC WORKS <br /> Estimated starting Darer c�i�'` O _�Carnorehon lk,Te � _tr P•.r. l C.r.i gran Date.._— --- -- <br /> I (or We) hereby apply for an encroachment poqr it to carry out the following work:,0�T�LjZyl/-6w-- gl"K <br /> fin aba" "rrwd opprtcan► t—wby :+4-asra Parmissie*)a , PCRMIY ICL ............. ...... ..,............ Z_ <br /> AW'f' cal r'8ot6ae Fee -- <br /> ]ewer 1cv Deposit ................ ........ .. ... .. <br /> TOTAL DEPOSIT ..... . . ........ . 1 -- /d <br /> i <br /> Budding Permit No. <br /> Improvement flan No. <br /> Supplemental Uoriditions: <br /> show skerch aims*er refer to drawing vjbr*rrtted <br /> —_�—s- <br /> IMPORTANT: Applicant hereby agrees to comply with al! provisions of this permit cis well as all applicable City ordinances, <br /> resolutions, swndords and sperifrrnrtnr1% tttiirtrtly it-, effect, and to pcy to City its actual cast for romoval and przoor replace- <br /> ment of any item which does not meet above requirements, Failure to co:rpfy will be cause for revocotion of permit. A.ppli- <br /> cont agrees to indemnify and hold the City harmless agoinst any and oil losses, costs, or damages result;--19 from ir.j,.rry to <br /> persons, death of person or damage to proverty occurring at the site of or as a result of work to be performed udder this <br /> permit. Certificate of insurance will be presented by cpplicani upon requesT. <br /> Reed General Provisions on reverse Side of this permit before signing. 'Notts requltoment of notlticatlons and inspections. <br /> Pormil EnginGarllnspoctor <br /> 444-8492 <br /> 844.836$ <br /> lit---Aerrnrtti. 40—Uhlity/Shier <br />