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08/15/2008 13:39 5102081604 ETIC ENG. OAKLAND PAGE 02/02 <br />• • <br />CITY OF STOCKTONDEPART ] 1 6 3 6 <br />PUBLIC WORKS DEPARTMENT <br />APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br />Applicant's Name CTTG Date 744'yldf APPROVED: BY THE PUBLIC WORKS DIRECTOR <br />(Owner/ii215E�(2 0 Z H 7/L' Subject to the General Provisions and Special Conditions, <br />Address 44!�e"~e Phone and all work must conform to the project's approved Storm <br />City Statel-A Zip 4?[r z,3 Water Pollution Prevention Plan or the most current version <br />of the City of Stockton Storm Water Pollution Prevention <br />Location of Proposed Work, etc. T rke nele t A f > C•r�� Maintena ce Staff Guide, whichever is applicable. <br />/'97'r 157/ l.,,,1 J S'r/yzr 044 ✓ew --7- <br />j r- <br />Owner/Contractor Address Z2y MdY>"41`A evr le /0s3 r+ <br />rH+I/ Cfi By �� � Dates /"�3 <br />Estimated Starting Date FitV161Y Gompletion Date � f 2 >'Ua�- Permit Expiration Date-„_,���i <br />I (or We) hereby apply for an Encroachment Permit to tarty out the following work: <br />'4J voo(,c -Th,Ca Q) Sd i b��+�5f «/pn <br />Sao`✓rYe- a/�r`r <br />vy4'1 /�. Cwl..�,or�s. ez..� ori+ /.oda ar•�(t..r /dd�Toi <br />ir1 t <br />GNt// /JL ..esee` //�-v /_lOC`-rG �=T/./Jdi�-Sa rT vWG✓r.+ S Srs-”" u��"e� ,Cit ILSe�( I'at G��'i.'r fyw, <br />ATTENTION: Applicanticontractor - you are responsible to <br />replace all broken, damaged, and/or raised sidewalk, curb and <br />gutter from score mark to score mark adjacent to the parcel; <br />remove USA markings upon completion of the permitted work. <br />Thu nbovb named applidnt nereby regneva permi'nlon to; <br />PERMIT FEE ........................... $ 50 &/— <br />Additional Footage Fee .......... $ <br />Sewer Tap Deposit .................. $ <br />TOTAL DEPOSIT ...... $ r <br />Building Permit No. <br />Improvement Plan No. <br />gore <br />Supplemental Conditions: <br />Df (` <br />ort <br />C,9F <br />ho�lnrx � <br />FFRtPol I NOT 491 KA WITHOUT A So <br />CONTROL NUMBER. <br />(ALL (209) 837-8366 TO REQUEST A CONTROL <br />NUMBER NO LESS THAN 24 I10URS, BUT NOT IK <br />EXCESS OF 72 HOURS PRIOR TO START OF WORK. <br />CONTROL# — <br />Sho k,.t.h above or rarer m ortmmg o„o„u,..� , <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 the City its actual cost for removal and proper <br />r places to indemcement of nify and hold <br />item which <br />does not meet the above requirements. Failure to comply will be cause for revocation of this permit. App <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 />occurring 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 Risk <br />Manager prior to Issuance of this permit. <br />IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE OF A CONTROL NUMBER, THE CONTROL NUMBER WILL <br />BECOME INVALID AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. (FOR CAPITAL IMPROVEMENT PROJECTS OR <br />SUBDIVISION IMPROVEMENTS, PERMITTEE SHALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT (209) 937.6411 FOR SPECIFIC <br />INSTRUCTIONS TS PERMIT, TO THE BEGINNING OF <br />SHALL CALL Y W RK.)361IOR TO ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE <br />SIDE <br />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFOR ZONING. R <br />e Phone: l.r6©z r42 -!'b <br />Signed; s <br />--Srowf, ()7(c - <br />1 <br />s' -Permittee (white) 2nd-Inspcctlon (pink) 3rd -File (yellow) 4t" -Finance (white) <br />