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Permit Number <br /> 5CITYOF ENCROACHMENT PERMIT EP21-0124 <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY <br /> Applicant: <br /> G H D Services' Date:Inc. 1/5/2021 �i APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Z Subject to the General Provisions and Special Conditions,and all work must <br /> 4080 Plaza Goldorado Circle, Suite B C) conform to the project's approved Storm Water Pollution Prevention Plan or <br /> Address: N the most current version of the City of Stockton Storm Water <br /> J Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> Cameron Park CA 95682 <br /> City: State: ZIP: Q 1/21/21 <br /> 530-558-1921 �/an.bastl(^(/�ryhd.com o By: '`9"- `Z`-� � Date: <br /> Phone: E-mail: '] vy <br /> ssociated Permit(s): Expiration: 2/28/21 <br /> WORK LOCATION: Sperry Ave 138 Sperry Ave PERMIT NOT VALID WITHOUT A <br /> Start Date: 1/25/2021 Completion Date: 1/29/2021 CONTROL NUMBER <br /> CALL(209)937-8366 TO REQUEST A CONTROL NUMBER NO LESS <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, THAN 24 HOURS,BUT NOT IN EXCESS OF 72 HOURS PRIOR TO START <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the <br /> OF WORK. <br /> parcel;remove USA markings upon completion of the permitted work. <br /> CONTROL# <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> Install one (1) groundwater monitoring well on the east end of Sperry Ave. <br /> Show sketch or refer to attached Drawing Official Use Only <br /> Refer to attached drawing for well location Base Permit Fee $ 523.00 <br /> Additional Footage Fee $ <br /> Misc. CRS FEE $ 31.38 <br /> Misc. TECH FEE $ 39.23 <br /> Misc. $ <br /> Total $ 593.61 <br /> Special Conditions: <br /> call for control number prior to start <br /> 209-937-8366 <br /> call for inspection 209-639-1282 <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 ANEW CONTROL NUMBER. PRIOR TO /E.Y �CtQ <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 Ran Bast <br /> SIGNING. PrintRyan <br />