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APPROVED: PUBLIC WORKS DIRECTOR <br />0 -2q-C)6 . Date <br />Mit Expiration Dale <br />pEAMIT FEE <br />Additional Footage Fee <br />Sewer Tap Deposit . <br />TOTAL DEPOSIT <br />Suilding Perrhit•NO, <br />Improvement Plan No. <br />Suo plemental RonditiomN p: <br />‘,..) ' U•.)‘1\ \*'t <br />s <br />E .14iree Ave, <br />Show sketch above or refer to drawing subrmfforf <br />kuleA. --Atal 6e., a kv,t04141,14 <br />0-q4c tt0-c` su <br />,b0 cb..ges qre-pett T <br />The abovc named apOlIcant hareby requests permission to • <br />I <br />FRON : GETTLER-RYAN INC. PHONE NO. : 916 631 1317 Oct. 24 2000 11:14AM P2 <br />CITY OF STOCKTON <br />DEPARTMENT OF PUBLIC WORKS <br />APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br />64848 <br />40:cant's Name .6 1 Date cl2_3/0) <br />(Ownerrcippira9top, <br />Address /61-f Ueda (Arb•ff_ Ph0no6114 - ggi -13 _03 <br />Location of Proposed Work, etc. hA iiicir J5j 01- PI mr <br />courS, Cdatme.. 0.5 <Luv, -1L-1c1 <br />Owner/Contractor Address <br />Estimated Starting Date 10/3P 49 ,ompletion Date <br />I (or We) h eby apply for an roachr nit to parry ut the follotting work : <br />mar% _ 11 _CI- <br />_geignfar3Q,C---CiAkk.Co <br /> <br />IMPORTANT Applicant hereby agrees to comply with all provisions of this permit As well as all applicable City ordinances; resolutions, <br />standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replacement of any item which <br />does not meet above requirements. Failure to Comply will be cause for revocation of permit. Applicant agrees to indemnify and hold <br />the City harmless against any and all losses, costs, or damages resulting from injury to persons, death of person or damage to property <br />occuring at the site of or as a result of work to be performed under this permit. A certificate of insurance shall be submitted to the <br />City Risk Manager prior to beginning construction. <br />PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1-8004:2444) TWO WORKING DAYS BEFORE BEGINNING <br />WORK FOR LOCATION OF UNDERGROUND UT1LMES. <br />PERMITTEE SHALL CALL (209) 937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br />INSPECTION. <br />Read General Provisions on reverse side of this per — Note requirement of notifications and inspections. <br />SiOne0 „0, 9'14 -63 1-1302) <br />Int—Permitter: 2nd—File ard—Finoncc 41h—Utility/Slrael