Laserfiche WebLink
02/ 02/ 2001 16 : 00 5306766005 STRATUS NO CALIF PAGE 02 <br /> M CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKSAF 65876 5 0C� 7 6 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY CC33 Cyt <br /> AOP"Anrs .rJame Date . Ioa <br /> . ' G•r l 1 r' <br /> {o wnedco-nnttraactor) /� <br /> Address t eJJ✓� m t+�n Aow&& 117 . '1 Phone -L <br /> city tEt state TJp APPROVED: PUBLIC WORKS DIRECTOR <br /> t-ocailon of Proposed Work, et/c. .f D <br />{ owner/ contractor Acidreaa a <br /> j 11 " y° y Date <br /> Estimating starting Date (� a $�10 ;r completion DateN6V2m�7Ps <br /> . Permit Expiration Date <br /> I (or We) hereby apply for an enrbachment permit to carry out the following work 4" i 1 5 } � <br /> 'ta r e dta 5F- Fi moltf n <br /> 1 .0F, Pro nn 5ZA buri <br /> !' alar-i2Y7n S.+a : <br /> a ;u: awkr ( �' . t7cA4r< Car• 7_ - ; ,... <br /> �✓k:! t±-n ptTr- G�i �it? ' nKfstL{xc✓t �L'fx E r� S7-. 'p <br /> Sid <br /> r i {y�i[g �: • m CeYs' �/iG <br /> � rut afd�k't �`aM �,74 u.+n <br /> rho above named applicant hereby mgoeels Pwm,sainn to - <br /> PERMIT FEE ....... .---...... ski <br /> ,............... $ Z <br /> Add tonal Footage Fee ........................_. $ <br /> S,eworTap Deposit ........................ :.__.. .� <br /> TOTAL DEPOSIT ............. $ � �'.. '� <br /> Building Permit No, <br /> Improvement Plan No- _ <br /> Supplemental Conditions: <br /> +� �� �v,�_ �E�• �1� cwt�� �d <br /> Show sketch above or migI drowns BUbmlllod <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 the <br /> 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 City <br /> Risk Manager prior to beginning construction. <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (7 -300.642-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND <br /> UTILITIES- <br /> PERMITTEE SHALL CALL (209) 937=347-}.;Y4 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. $ j <br /> Read Genera( Provisions on reverse side of this permit before signing - Note requirement of notifications and inspections. <br /> etned. 5A 0A <br /> Wnana:S3r7-676- Elba <br /> 1•i-Permittee 2`1 3rd•Kl�nce <br /> 6th•UOlily/Slreot <br />