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JUN-06-2007 WED 01 :27 PM GALATI AND BLEK LLP FAX N0, 9164416553 P. 05/05
<br /> CITY OF STOCKTON 110 9 S
<br /> PUBLIC WORKS DEPART'MEN'T
<br /> APPLIMICIN FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY
<br /> 6lpptic.cuit's t I,t;ncr :' -. -_�_' t�"i e°Q- —._ 4 'f 1I APPROVED: BY THE PUBLIC WORKS DIRECTOR
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<br /> Adilrc ....
<br /> •1 rr�.� .`` ,, .,,Y�,�:._t_.��1__ hone__�•,_ ..__ ���'� �� SuhJr.ct to rho GOnCral F'rgvlsion:r and Sp+3cial t.onclitions,
<br /> City r��V �r and all work mint conforill to the project's approved Storm
<br /> y_-_-, .;�.__ _ Slft% . Zip ?1/ — Water Pollution Prevention Plan or the most current version
<br /> r of tho Cit of Stockton Storni Watr r Pollution F'revontion
<br /> l.or;alion of Pr(,.)Pw c:d Work,etc". h,a^�.L� ;�,br�(� Maintenancca Staff(auf�dc, wlriehever Is npplicablo.
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<br /> Uwnr3rjCorrlrt:ir:tt'ar IltJrfro;sr - -`-, _ y __, „ ' aic
<br /> �,,.,.....�..Y..,......_-... ,.. �_��_all'` �'P.�_ Permit Expiration Dain
<br /> fa9lrnatcatf Starting D&to g�'%__/!�_'�_._�_. Completion Date I —�_�' � ,_._..-........
<br /> IA•mklrwwwiwiNwN..wwr.wrtW'#iM.Igw.L.-+nmrvMH���M'.4NWrw'dxu�MiwJIMMYgWq �4
<br /> ply for ixtl Encroacji of F'erinit to curry out the followin work:
<br /> tar w:} ftor�:,y,7fa -------.._..,_.--
<br /> ATTENTION: you arn rcrponsiblo to
<br /> roph;. o -.illhticxwaglodnd/or Tai,:.cd sidewalk, curb and PERMIT FEF........ . ........ ?
<br /> t)r.tlor frorp sr^nrO n}trk to scare ni arl(adjacent to the parcel;
<br /> romewo USA ni,iddo(p, upon completion of ilia permitted work. Additional C'ootage f-`ee; ,......... $ -- _ -- -
<br /> 17na�r,wn omr,,,o npf,ilmot hrrreq roqur:ora pnrmdsmlon to:
<br /> Sowor Tip Dcpooit.................. t; V/9"
<br /> -
<br /> TOTAL.DEPOSIT ...... $
<br /> Building Permit No.
<br /> Improvement Pian No.
<br /> Su{/pl lemFin/tal Conditions:
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<br /> C,A[l_ O,C)")
<br /> f;l.%°tY�;.wit �df� �I°�ti�`� 1"Iwi.'i��i Cit?l.Ii;.:,, ��1,1'p' !'if,?'l ;•
<br /> (•�7Ctik'f;�f;lig€'1,f•li:?Lr'r �i 1'itE(:';'�-ff,l,:�1:�,.P:�f`�a(�l'rrC);.i
<br /> ('ha+r;';k+7ch nl nv�ur ruh;r t+drav iu�rul.ante..
<br /> IMPORTANT: Ar),)lit:ar t horoby agroes to comply with all provisions of this perrnit,ar>wall n:a ail applicnhio city ordinnricer,, tQsoUtiuns,
<br /> �t:ancfnrrls c111d f,pcoific:aiions currently in offoct, and to pay to tho City its actual cost for removal and proper roplarernont of,iny itom wl-iirla
<br /> do6);; not mont tho ohi!lvo re(iulrorrlents- Failura to comply will be cause for revocation of this permit.Applicant tigreos to indF,rnnify and hold
<br /> tho lily harmlo n ftny rand all 1ni„r�., costs,or damages rosulting from injury to persons, doath of per son or d amago to property
<br /> occur ring at the eitra of, or Fu, n rOSUlt of,worl(to he performed under this permit,A cortiflcate of insurance shall be submitted to the City Rlsk
<br /> Mari,,v)er prior to of tt)Is pCrmit.
<br /> Il-THE.W01,is I:tO No i,COMMENCE,WITMN 72 FIOURS OF THE ISSUANCE OF A CONTROL NUMBER,THE CONTROL NUMBER WILL
<br /> RECOME INVALID ANP T14E:PERMI174.5 SI'IALL.CALL FOR A NEW CONTROL NUMBER.(FOR CAPITAL IMPROVEMENT PROJECTS OR
<br /> St1601VISION IMPR(,)VEMI::N'E'S,PEgMITTE1.SHALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT(209)9374411 FOR SPECIFIC
<br /> IN STHUCTIONS f'RIC'Yft TO THE BEGINNING OF ANY WORK.)PRIOR TO ANY REQUIRED INSPECTIONS,A$IDENTIFIED ON 1 HE RFVERSC
<br /> SIDE"OF THIS Pig RMi t,PEIRNIfITEF SHALL CALL.(209)937-8381.
<br /> Rf.'.AD GF-I I-HAt.PROVISIONS ON TNF.nFVEF7SE SIDE OF THIS PERMIT BEFOR-S NINia.
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<br /> aSlaned: ' ',t ]rC:z
<br /> 2`111 drispection(pink) 0 File (white)
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