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of ZIP: q <br />V aft-C1 C 16r- <br />acIN tie 0 ,-eY1\ - eDril <br />City. c>-FiAl4-111 State:. <br />Phone: E-mail: <br />WORK LOCATION: <br />1 <br />4 4-ek neat- C. <br />ATTENTION: Applicant/Contractor- you are responsible to replace II br, en, '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 />Start Date: q; Completion Date: <br />it 9, pot I <br />Date: <br />Expiration: <br />f te <br />ENCROACHMENT PERM# <br />ON PUBLIC' RIGHT-OF-WAY <br />11 IC110 <br />scITY OF <br />STOCKTON <br />Applicant:cigvit.ec'&o67jiirmiYetel--6,1 Date: <br />Address: (1.)-9--- (31,17f (61 <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />Mil(4 'AN1) () h)Nt' fYI`e PTY <br />wc*1( 9 e, c71 <br />Permit Number <br />VFW 1 1.4 <br />APPROVED: BY THE DEPARTMENT DIRECTOR <br />ubject to the General Provisions and Special Conditions, and all work must <br />onform to the project's approved Storm Water Pollution Prevention Plan or <br />he most current version of the City of Stockton Storm Water <br />Pollution Pr venticy aintenance Staff Guide, whichever is applicabl <br />PERMIT NOT VAUD wm-fouT A <br />CONTROL NUMBER. <br />CALL (209) 937-8386 TO REQUEST A CONTROL NUIZER L.F_ss Pon 24 HOURS, BUT NOT IN <br />EXCESS OF 72 HOURS PRIOR TO START OF MIK. <br />CONTROLt <br />Co(I (- I CU <br />Show sketch or refer to attached Drawing <br />ott-rcfrfrej <br />Official Use only , <br />Base Permit Fee $ g7-3- e'e <br />Additional Footage Fee $ <br />Misc. <br />7729771 13'5— $ 39 - <br />Misc. (leer /QC- <br />------ <br />$ c3/ 38 <br />Misc. . $ <br />Total $ 923 4e6 <br />Special Conditions: <br />— coNtr4e--7 - <br />374-5.0t-i G.vol <br />IMPORTANT: Applicant Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, Standards anc <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 anc <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 <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 ef'w k- r