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Official Use Only <br />Base Permit Fee $ 52-3 OD <br />Additional Footage Fee <br />Show sketch or refer to attached Drawing <br />Set ciAtAwi si \.f ()LIR <br />Misc. -r-E-Cf-i- <br />misc. <br />Misc. <br />Total <br />Special Conditions: <br />- an -159- — e>34H +r) <br />re-÷keS cortl-h2) kvonke+-- pr i`o}- <br /> <br />4r) c4-tAiri , <br />-‘7r ;ktJpdQ41c-e4417(4-- <br />ofrt a-01-vset <br />Permit Number <br />CPR -Ibt1-3 aSSITY OF <br />TOCKTON <br />Applicant: S'Irt.tIL i viii uviti* TV6e <br />Address: `335/ ILKivf, <br />City- (411AtlYt P611( <br />Phone: 63011 <br /> <br />State: <br /> <br /> ZIP: till Z.- <br />".5-6.hs “if <br /> <br />E-mail: 5 <br /> <br />WORK LOCATION: -fro l'a) (Lek; it rff S /ally vi <br />Start Date: <br /> <br /> Completion Date: \O Odi k" 'DUO <br />i a A 57/ l'f-• 0/3 i <br />ATTENTION:Applicant/Contractor- you are responsible to replace all broken, a <br />h <br />ged, <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 />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />By: Mohr I< Ca/r-00,11 Date: GI/Z," <br />Associated Permit(s): )64,2 Expiration: 1921/4— <br />APPROVED: BY THE DEPARTMENT DIRECTOR <br />Subject to the General Provisions and Special Conditions, and all work must <br />conform to the project's approved Storm Water Pollution 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 />ENCROACHMENT PERIM <br />ON PUBLIC RIGHT-OF-WAY <br />Date 87-1Z-11 <br />/1.(Avotelq (;0', 6,15, (pAsioid -kb 9 ebtAivief ozoki, ./.5 <br />p,e4 ¼JfCV ud,i 54, 0/ , <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 />1.(Jv14 <br />(YN'Iticdcj <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. Print <br />414 j,