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SCS o� <br /> ENCROACHMENT PERMIT Permit Number <br /> STOCKTDN ON PUBLIC RIGHT-OF-WAY <br /> Ron Gestler(Geosyntec Consultants, Inc.) 7-255-2022 } APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant: Date: _J <br /> Q z Subject to the General Provisions and Special Conditions,and all work must <br /> 1340 Treat Boulevard, Suite 208 0 conform to the project's approved Storm Water Pollution Prevention Plan or <br /> Address: /� v) the most current version of the City of Stockton Storm Water <br /> 94597 � Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> Walnut Creek CA <br /> City: State: ZIP: Q <br /> Phone: <br /> 925-278-8688 E-mail: rgestler@geosyntec.com o By. Date: <br /> ssociated Permit(s): Expiration: <br /> WORK LOCATION: Sidewalk near to 2025 Old Spanish Drive, Stockton PERMIT NOT VALID WITHOUT A.I <br /> Start Date: August 18, 2022 Completion Date: August 18, 2022 CONTROL NUMBER <br /> CALL(209)937-8366 TO REQUEST A CONTROL NUMBER NO LESS <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, THAN 24 HOURS,BUT NOT IN EXCESS OF 72 HOURS PRIOR TO START <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the OF WORK. <br /> parcel;remove USA markings upon completion of the permitted work. <br /> CONTROL# <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> Installation of a set of dual-nested soil vapor probes into a single 3.5-inch diameter borehole of ten-feet depth <br /> in the City of Stockton's sidewalk (right of way) adjacent to residence at 2025 Old Spanish Drive. <br /> Show sketch or refer to attached Drawing Official Use Only <br /> Please see attached maps and figures which present to <br /> planned location for the borehole. Base Permit Fee $ <br /> Additional Footage Fee $ <br /> Misc. $ <br /> Misc. $ <br /> Misc. $ <br /> Total $ <br /> Special Conditions: <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 Sign j6Z <br /> PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT(209)937.8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE Ronald M. Gestler <br /> SIGNING. Print <br />