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WORK LOCATION: 2cccl) 02) • ...0041‘`(\3turN,CA-VN -et -4 <br />-NA <br />Start Dat <br />( <br />es 1 t k Completion Date.--94IrC:, <br />ATTENTION: Applicant/Cobtractor- you are responsible to replace al bro en, damage , <br />and/or raised sidewalk, curb and gutter from score mark to score mark adjacent to the <br />parcel; remove USA markings upon completion of the permitted work. <br />Applicant: \\ W(.\,\ i\L-)a\ylonctlzi \A-Date: <br />Address: 73:2*/CF1 t-t4Y \C:i -1)(116 <br />City:Q11M\--In CNC\ 0 \ta. State: C A ZIP:CIS 141- <br />Phone. (Cl -(1.1)5C1 E-mail: VphSVICITC(Iat\ •C\E, <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />Show sketch or refer to attached Drawing <br />$ <br />$ 3).3e <br />Total $ <br />"Ii <br />Special Conditions: <br />kij rflitkki cv wt <br />Ovi -044- Art <br />4191 -631 - I B 2,- <br />Nicytify Ark) aco.trr PrPre,*-O(AW <br />etf - )-eAft hOWYV pry <br />s t-vor-K. <br />Base Permit Fee $ <br />Additional Footage Fee <br />Misc. <br />Ewiles- i.4011,v44096 riotsf./ <br />P2Pie4-IcJ 4V4 00- 4?-1 -05517 <br />or in5ret,ii 0 in <br />139- -6 341 4n-- hol ti4140v- <br />Official Use Only <br />Misc. --rptif <br />Misc. Z.f <br />Sari OF, <br />STOCKTON <br />ENCROACHMENT PERNigr <br />ON PUBLIC RIGHT-OF-WAY 2# ?op <br />Permit Number <br />APPROVE TaH.E DEPARTMENT DIRECTOR <br />'subject to the. General Provisions afft1 Special Conditions, and all work must <br />unform to the projects approved Storcn1/VateiPollution Prevention Plan or <br />the most current version of the City of Stockton Storm Water <br />Pollution Prevention Maintenance Staff Guide, whichever is applicable. <br />By. t+ACI K-- Cara a.14 Date: / <br />Associated Permit(s): RPe17- 2-0 Expiration: / 7- /."-• <br />/ <br />PERN9T V OT VALID WITHOUT A <br />CONTROL NUMBER. <br />CALL 7*A) 937-a3SS TO REQUEST A CONTROL <br />LESS THAN 24 HOURS, BUT NOT INI <br />EXC CF 72 HOURSPTTOF WORK. <br />CONTROU1 <br />L-ViVA.Lk CAAA: OA k1C)\(' V1A3 PiU1/4) eV.) krrk-Ct \ and <br />ow.snr-Dm cac, <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 remova 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 A NEW CONTROL NUMBER. PRIOR TO <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 <br />SIGNING Prirt Cf c-2L-)€ yA— SCi,_915,.) <br />