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CITY OF <br />STOCKTON <br />IoW <br />ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY <br />Applicant: 1)"rA. LZ,C-z SLS Date: `a' 2.1 - <br />Address: Z � S t <br />City; �,�� State: ZIP: <br />�- <br />Phone: <br />CPT-- Is Permit Number <br />EP22-0590 <br />APPROVED: BY THE DEPARTMENT DIRECTOR <br />bject to the General Provisions and Special Conditions, and all work mi <br />nform to the project's approved Storm Water Pollution Prevention Plan <br />most current version of the City of Stockton Storm Wa' <br />Ilution Prevention Maintenance Staff Guide, whichever is applicable. <br />3/17/22 <br />WORK LOCATION: -Z.L o- p� 2 e _ �' PERMIT NOT VAMIMHOUT A <br />Start Date: j ' Completion Date �+ a O ' * OL NU""' ,' rr <br />c I.L (209) 937466 TQ R8O4' -V A UMM <br />nt/Contractor- you' a <br />rerespS ble to replace all broken, damaged, ApplicaPUP <br />2'HOUPS,BUT NOT i <br />and/or raised sidewalk, curb and gutter from score mark to score mark adjacent to the EXM�aSS OF 72 HWRS PRIOR TO SART OF' {r(, <br />parcel; remove USA markings upon completion of the permitted work. ��--++�'Iklrit If�1 f <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: ` �• 4 S �� Q t `� <br />�e �D ��: �o VZ o 0\& <br />Show sketch or refer to attached Drawing Official Use Only <br />Base Permit Fee $ 523.00 <br />Additional Footage Fee $ <br />I- CA,L Misc. CRS FEE $ 31.38 <br />--�� �-E�[ `\c� �PJ� Misc.TECH FEE $ 39.23 <br />Misc. $ <br />Total $ 593.61 <br />Special Conditions: <br />Call for control number prior to start <br />209-937-8366 <br />Call for inspection 209-639-1282 <br />72hr no parking notice <br />Coordinate with property owners affected <br />Must maintain an ADA path of travel at all times <br />9am -3pm <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 <br />PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (209) 9378381. <br />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. <br />Sign <br />Print �h <br />