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Permit Number <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 Prevention Maintenance Staff Guide, whichever is applicable. <br />By: Date: <br />Associated Permit(s): Expiration: <br /> I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />ATTENTION: Applicant/Contractor- you are responsible to replace all broken, 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 />IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolution s, 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 o f, 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 <br />Sign <br /> Show sketch or refer to attached Drawing <br />Base Permit Fee $ <br />Additional Footage Fee $ <br />Misc. $ <br />Misc. $ <br />Misc. $ <br />Total $ <br />Special Conditions: <br />ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY <br />Applicant: Date: <br />Address: <br />City: State: ZIP: <br />Phone: E-mail: <br />WORK LOCATION: <br />Start Date: Completion Date: OFFICIAL USE ONLY Official Use Only <br />PERMIT NOT VALID WITHOUT A <br />CONTROL NUMBER <br />CALL (209) 937-8366 TO REQUEST A CONTROL NUMBER NO LESS <br />THAN 24 HOURS, BUT NOT IN EXCESS OF 72 HOURS PRIOR TO START <br />OF WORK. <br />CONTROL # __________________________ <br />EP21-1713 <br />Hannah Wong <br />Antonio Pinillos <br />9/9/2021 <br />11/9/2021 <br />523.00 <br />CRS Fee 37.38 <br />Tech Fee 46.73 <br />707.11 <br />- Call for control number prior to start 209-937-8366 <br />- Call for inspection 209-639-1282 <br />- 72hr no parking notice <br />- 72hr RTD notice <br />- Coordinate with property owners <br />- Must maintain an ADA path of travel at all times <br />- Restore to City standards <br />- Work hours 9AM-3PM