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WORK LOCATION: (JO 110% +-tUn,Vel- g-t <br />Start Date: Completion Date: 7 6, 413, <br />ATTENTION: Applicant/Contractor- you are responsible to replace all broken, damaged, <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 />Misc. <br />Misc. <br />Base Permit Fee $ <br />Additional Footage Fee <br />Misc. <br />Total <br />Special Conditions: <br />--ze To 156 tt..1 Povpie-iNal ukt4E <br />12651roasp Arcur-pt Oa/ <br />51-46.JDA4242, (3:1400vAfte <br />CAW-- (19,7' 82-4013 aq2- <br />C.041VOL- tifrutaig- Ttzttle.:10 <br />STAR-1- <br />I Nr791rre-Xt <br />IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applica le ordi ances, 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 />Official Use Only <br />$ <br />$ <br />Show sketch or refer to attached Drawing <br />CITY OF <br />STOCKTON <br />ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY <br />Permit Number <br />tiN3-1094, OFFICIAL USE ONLY Applicant: 16S\ 114- Date: 5/25119 <br />Address: \ fr‘ k. 2cA3 <br />State: C'A CZIP ISL3E I <br />E-mail: 224V...kstvoSA;r1(21 S;cto <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 aintenance Staff Guide, whichever is applicabl <br />Date: <br />Associated Permit(s): Expiration: <br />City: 1\1‘(42-40 <br />Phone: (201)5T1 " 222i <br />vCji MLR) WITHOUT A <br />CONTROL NUMBER. <br />CALL (209) 937-8386 TO REQUEST A MITROL <br />NUMBER NO LESS THAN 24 HOURS, BUT NOT IN <br />EXCESS OF 72 HOURS PRIOR TO START OF %OM. <br />CONTROLS <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />\rA-71.4:10C (2) s-6\ bed( \fT A f‘i- SAOL4SX-Cci 2 NA bad <br />&Pr\ Sk, \(S. <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 <br />PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (209) 937.8381, <br />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. <br />Sign <br />Print <br />