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RPR-01-1998 1544 PUBLIC WORKS PERMIT CENTR 209 937 8901 P.02 <br /> 1 64635 <br /> ., ® 1 r • CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> .( (1 APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> ,. ueanlb Norma 1 liO�Pm�Q1 S O'(� <br /> Date <br /> ` ,°.;;=acw)3 !n E1;1o•es S�cec1 r,xP�(Alb�'Sbl€ 11,'. <br /> (y10.{ 1011 Cry f{SbSS °I 9 L'� r etre fr Yi, APPROVED: PUBLIC WORKS DIRECTOR <br /> LoWIM of Proposed Work.ate. ( r . .:� 1 ,\ <br /> ♦ ol+ en <br /> Norah f ZQio \N WOhm4pee �k L'I <br /> OwnarfCmnlretW AddMs f `ry(t111n—��-�61 0 \1\At'..cr� �Dorf•..: 44124 /0-1 <br /> 7LA- a,3--) ��- Z'S' Permll E•fdrMbrr DW <br /> s , we} hereby apply for an encroachment permit to early vul in, luuVwruy wvt. <br /> tv 'iVeP r <br /> •\ ! t l-t <br /> - <br /> Ir�ri�t re i..t evri: : „•,ra:i r ..mr :°`.<.YN ftir: 1eea'a •'v'4Zii:i z_a --=.� a -e_. i.:, �— -__- <br /> TM•ama named•pp,tv.. bnW mpuvsl.pe!ml•elen la- PERMIT FEE. _....... <br /> .Addllienal FooWpp FOR............. _--_. - <br /> Sewer Tap Deposit .......... <br /> TOmL DEPOSIT .... .S _ <br /> ae:'2, cta�hec.t Building Permit NO. <br /> f <br /> (�(UuJin Improvement Plan No. <br /> Supplemental Conditions: <br /> e" <br /> i <br /> 1 <br /> SMerriksldtt amw,w M.r to ansae stAA,nlsd <br /> h�onwrnnrr AooI!ram hereby agrees to comply with all provisions of this permit as web as all applicable City ordinance.-,resnpninnc: <br /> qui iauor <br /> r:__ .d\„ ., +..nn.,dhi <br /> .aclt,.1 en Inr rcmmal and proper replacement of any Item wt,r <br /> \r\O F.,ie nArrnrP!.0 epai .s\unv altp or•rGaaaar a.v.aw.•+• •+u ..yv - -- '-'�' '-- <br /> 1 D.-Yunna a! Ilr�'its L%i v'S '" •.61.vw!i°r• 'wrrra r,_. v_.v_ .�.......a-.. •..v_ a . .. r� ..-. .. -..- .. <br /> v v _ -r r <br /> City Risk Manager prior w o"inning construction. <br /> ann��--••:^_'•w ur�wutn ..ave novMOC OCNnINiry_ <br /> PERMITTEE SHALL CONTACY UNDERGROUND SERV- <br /> -EE$HALL <br /> £r:= "EE$HALL CALL isYy)y37-54-11, iiivirnw:'.�ov. •..yr .... ... ..,....., aw:,...•...6mci;,+..z •INSPECTION. <br /> Read <br /> -_ <br /> Read General Provisions on reverse side of this ppimit before signing Note requirement of noiiirc�: <br /> 1 I"11.INlr I Aa t/o..r.•r\ Nlll _.l_'T /GJvv• +v r., <br /> I �mV <br /> w pre—FW,te •rn—Vnlurr3+••a! <br /> tn—Pv.a,n,v <br /> I <br />