Laserfiche WebLink
"� .x jam. .:•� � � �,..1 <br /> CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC W <br /> APPLICATION FOR ENCROACHMENT ON PU RyRNPOF-WAY <br /> Applka 55762 <br /> Address �Ak �C-1 phot 9/6 9-/–/AV a - <br /> ��Y��?� 4PAP Of: PUBLIC WORKS <br /> Lpaofian of Proposed Work,etch /� ,._ <br /> T Qsa�s G�orA � y . <br /> /Contractor Addrps Oi � � /�5,j25EW _ gy Data <br /> Estlmmed Star ing pate lfp ,Completion Data E S Permit expiration pate <br /> I (or Wei hereby apply for an encroachment permit to tarry esut the followinwork: � � <br /> a� ; . <br />!' l t41Y-Z�� ,telLow— <br /> r <br /> ' - 11y above nomad applicant lwrvby requests permitsion to <br /> PfRMiT FEE................. <br /> A!"tiwwt Footnpe Fee.,....... ............. <br /> Sewer Tap Deposit <br /> TOTAL DEPOSIT ........................ 3 <br /> 1 Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> Show sketch above or refer to drawing submirred <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, <br /> resolutions, standards and specificotions currently in effect, and to pay to City its actual cost for removal and proper replace- <br /> ment Of any item which does not meet above requirements. Failure to comply will be cause for revocation of permit. Appli• <br /> cont agrees to indemnify and hold the City harmless against Qny and all losses, costs, or damages resulting from injury to <br /> persons, death of person or darnoge to property `occurring at the site of or as a result of work to be performed under this <br /> permit. Certificate of insurance will be presented by applicant upon request. <br /> Read General Provisions on reverse side of this permit before signing. 'Note requirement of notificati s and inspections. <br /> Perrnit Engineer/Inspector <br /> 944.$492 <br /> 944.8368 Siynad: —Phone—. <br /> ttf—OerMitlN 2nd--Fife are—.Finpnce aer,_1�f d.►v/Street <br />