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Crir <br />WORK LOCATION: aim <br />Start Date: toa'17--41/ <br />Phone :(4P 16D, E-mail: <br />vg.ev-eii/Vreffn <br />-Plr(c, StNe-1-- <br />jom L6 0 si-- <br />Completion Date: <br />ei-01-1-01(71-6 <br />ATTENTION: Applicant/Contractor- you are responsible to replac all br ken, 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 />Total $ <br />Official Use Only Show sketch or refer to attac ed Drawing <br />ko\c'tv k -ce 'ivefillatise4nkcyto Vt. <br />iq'tzr <br />0,e6 Per <br />$ 39 <br />$ 51 -u- <br />Misc. <br />Misc. Misc. <br />Misc. <br />Special Conditions: <br />il4SPECTIO czi•-kpare-,r" <br />,Acc•op.i 047202_ (:20043 9 -12402. <br />ntackeri ,e2; Base Permit Fee <br />Additional Footage Fee <br />CIO <br />Permit Number <br />Applicant: Moud Ae og,,,viayi Meth Date: <br />1CITY OF <br />STOCKTON <br /> ENCROACHMENT PERM11. <br />ON PUBLIC RIGHT-OF-WAY <br />'1161/E. <br />Address: qi1L1 \Aj Pt <br />City: 5 6'&117Y1 state: 011— ZIP: <br />By: <br />WA-I-QUI A <br />CONTROL NUMBER. <br />CALL (209) 937-8366 TO REQUEST A CONTROL <br />NUMBER NO LESS THAN 24 HOURS, BUT NOT PR <br />EXCESS OF 72 HOURS PRIOR TO START OF WORK <br />CONTROL# OFFICIAL USE ONLY r <br />Asso ated Permit(s): gr I 950Expiration:/2 <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 Pre ntion aintenance Staff Guide, whichever is ap licable. <br />Date: 7 <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />n‘54-0CA-F)r rNyvkt-er tAitt\f‘v6ri <br />br) o--F 4-61\ ardi <br />1 <br />(ctk- \ 66i) <br />\JI f ot ckNici c<i_ Thwo ( _ )tlx-t <br />011\i\el - 0,6161 t--1-)ervNal <br /> <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 A NEW CONTROL NUMBER, PRIOR TO <br />ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE SIDE OF THIS Sig <br />PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (209) 937.8381. <br /> <br />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. Print lip T-D'4-aa4or <br />