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Permit Number <br /> CITY OF NCRUAGHMENT PERMIT 6P19 -�32p <br /> m5STOCKTOIor / i`G ON PUBLIC RIGHT-OF-WAY <br /> /, 11 p� <br /> ( ./nSC�tle �`r��\"'`�%� r \ J APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant: Date <br /> Z. Subject to the General Provisions and Special Conditions, and all work must <br /> O �y t,� �U 11 J 1 T\ , �.`- conform to the projects approved Storm Water Pollution Prevention Plan o <br /> Address: '7 vt V5 the most current version of the City of Stockton Storm Water <br /> t , 1 L 1 /� G L` Pollution Preventio Maintenance Staff Guide,whichever is applicable. <br /> City: 4VChi\ SACV—vne k State: eA ZIP: r J v� a <br /> 11 11 9 1 CI IL- By: Date: <br /> Phone: quo C7 7 X " I I b 1 E-mail: ��CsSd UeS�('Rgt� �<'NV,;,a O <br /> ��j7 C-e 4 <br /> /, �1"� ssoc red Permitlsj: Expiration: /`f <br /> WORK LOCATION: 2DOS <br /> AMa,, . 'A-Ao, r-�•y r<. r Po^Ra <br /> f FiRIOTW F.AJ,ID %fitirTOUTA <br /> q r_ "` 42- rye.NT CA, E�va��is 1`h <br /> Start Dale: I C-' , Completion Date:� , <br /> CALL (200) 337-83M TO€MUEST A CONTROL. <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, NUMBER NO LESS TIM 2a HOURS, BUT i40T IN, <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the EXCESS OF 72 HOURS PRIOR TO START OF WORK, <br /> parcel;remove USA markings upon completion of the permitted work. <br /> COI' c ITI` - !, <br /> I (or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> i� ` <br /> V1+1` And ,li Al' WbH. �O N'cnCc 1hI<\�5 <br /> Show sketch or refer to attached Drawing <br /> Official Use Only <br /> Base Permit Fee <br /> Additional Footage Fee $ <br /> Misc. <br /> Mist:. CIPS hwe $ 6`1 •23 <br /> Misc. $ <br /> Total $ •b� <br /> Special Conditions: <br /> C*u- Faill'Ib TWO e�r►fiRo� fJt►wbg2- R�tfalR <br /> CAt,t� pINS;PiltT <br /> GG AcsT+r9-a�i �I <br /> ti To <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all a p ica e i drdiri�nces, 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 <br /> PERMIT, PERMIT-FEE SHALL CALL INSPECTIONS AT(209)937.8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE Print -lG cte M N V I��( <br /> SIGNING. <br />