Laserfiche WebLink
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 0 f <br />the most current version of the City of Stockton Storm Water <br />Pollution Prevention Maintenance Staff Guide, whichever is applicable. <br />By: M iw K C,Oxagma <br />Associated Permit(s). <br />Date: ,i/1 <br />Expiration: Vi5-7/7- <br />City: / <br /> <br />State: C4- ZIP: '457 <br /> <br />Phone. lc 9. /7 -10.0 k-mail -g,7::,,eavoL,4111V1tQE, <br />Cow, -1-x-c-f-- <br />lAaen.'/Le_LU <br />NOV 02 2L <br />ENVIRONMENT NIEALT4 <br />ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY mis5 <br />CITY OF <br />STOCK'FON <br />A (\ VAN 1.6 Gia e L <br />g irk Date <br />w PiNt.:0A-0 <br />Permit Number <br />Ey 13- - 155] <br />Applicant <br />Address: <br />WORK LOCATION: 4.15P5 EL &IAD° at. <br />C , PERMIT NOT VALID WifiliOUT A <br />Start Date..1.444 .--- Conipll?non Date Ale:cotirrnoL WESER. /69/1-7- / I CALL (200) 937-a38 TO REQUEST' A CONTROL ATTENTION: Applicant/Co tractor-you are responsible to replace alltrokenxiarnhe'cl, NalliER NO LESS THAN 24 HOURS, NUT NOT IN and/or raised sidewalk, curb and gutter front scor.e mark to score mark adjacent to the EXCESS OF 7.2 HOURS FROR TO START OF WORK parcel; remove USA markings upon completion of the permitted work. t7ournou <br />"...111ag...••••••SNOSU <br />I or we) hereby apply for an Encroachment Permit to carrycoi$the following work: <br />A ct trt;- tv1A2 r of,49 "70%) wt s <br />A Aro, Ctl) .66/\41.4 0,10! ht - f3vA Accti <br />°Aoki iv Ply AitrNA ito!ts <br />Show sketch or refer to attached Drawing <br />Official Use Only <br />$ 5-Z 5vr 1' ;) 1st P AVdv <br />Base Permit Fee <br />Additional Footage Fee <br />Misc. $ <br />Misc. <br />Misc. <br />F7r- `Ili r&c-1-1`0.-1 <br />Total <br />Special Conditions: <br />TitScii, E4r-- 201-403 rzf;,;., <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 CONTROI NUMBER, THE CONTROL HUMBER 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, PERNIITTEE SHALL CALL INSPECTIONS AT (209) 937 3381. <br />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. <br />Sign <br />Print <br /> <br />(---/ , 4 • <br />0 IN J Ctfl4 r <br />