Laserfiche WebLink
Permit Number <br /> „�CITYOF ENCROACHMENT PERMIT <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY N-D 7 9 3 5 6 <br /> Applicant Date: Y APPROVED: BY THE DEPARTMENT DIRECTOR <br /> ubject to the General Provisions and Special Conditions,and all work mb <br /> si <br /> Address: onform to the project's approved Storm Water Pollution Prevention Plan o <br /> the most current version of the City of Stockton Storm Water <br /> ollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: State: 4/.-A ZIP: <br /> j , By <br /> Phone:kp a�) E-mail: Maw N, � 4 Date:_LL3- <br /> IE <br /> a efiti'V\ Associated Permit(s): ' `Z� Expiration: 15 <br /> �I <br /> WORK LOCATION: Q R, <br /> tart Date: AK Completion Date: 1 C '1 ( �. It^e ^"�.• <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, )i.I 0 AN =w ..•:P 1,l.I n/)T N <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the 0, ADZ I hid <br /> parcel;remove USA markings upon completion of the permitted work. <br /> I(or we)hereby app for an Encroachment Permit to carry out the following work: <br /> op <br /> L� <br /> Show sketch or refer to attached Drawing <br /> fficla s Only <br /> L ✓�'' Base Permit Fee $ �i'S oo <br /> Q� Additional Footage Fee $ <br /> 7 <br /> Misc. S 6 $ <br /> Misc. $ C)d <br /> Misc. `�� $ <br /> Total �L s Is <br /> Special Conditions: <br /> l�q T Z1 I wL -S�,5 a) <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 ANEW CONTROL NUMBER. PRIOR TO <br /> ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE SIDE OF THIS Sign <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 /> e eer,a <br /> i <br />