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lVC OACHMENT PERMIT Permit Number <br /> CTTYOF ON PUBLIC RIGHT-OF-WAYS 77504 <br /> ESTOCMN <br /> Applicant:J�.>�7LMT 4 S-;-r.tArnE;S Date: , LU- Ny APPROVED: BY THE DEPARTMENT DIRECTOR <br /> 7� z object to the General Provisions and Special Conditions,and all work mus <br /> Address:.13 U 7Lr D([;,Wptjp t/Q St t tT's 50 conform to the project's approved Storm Water Pollution Prevention Plan c <br /> >' ? the most current version of the city of Stockton Storm Wate <br /> //''�� rr�a <br /> Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: _ ,w%r.n State: CA zip: 9!41?? Q ,()l ,r r� {,..,, <br /> j LL ay: 4tV i R �-Y. IAI 1 it X.' Date: <br /> Phone: 530 �tAoto 1G402 E-mall: tduAooii,rodri nii AG(D,, U- FF '7 J <br /> V <br /> ssociat7egd Permit(s): Expiration: <br /> WORK LOCATION: \1 Clit-3I T4 OF. 1b G i.I.A fltruf-, l) "'jt ()g t '�`" `'"� . a� .:' d"d <br /> Start Date: 416-114— <br /> IIfl -y Completion Date: -I ' CAU OKI) 937MM TO RF.4't3 rA a l <br /> I vL I Mules fs W; LES 24 JRS. KJ IN <br /> ATTENTION:A�linnt/C�ntract you are responsible to replace broken,damaged, 1f 72 i S.S M TO ST 1� <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the � h ` x, _ <br /> `s.:.➢UC. - . <br /> parcel;remove USA markings upon completion of the permitted work. <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> LAJCt.L. 10.-Pl h.1OJt~1wnE.r.fY" 4 Lk 2 141JE AC-1 I ,rip< n" lknyr �t4l.tr fJ (i".t-T -, <br /> S�-rLACEiT-, Siil 14 41 t 7V Lt rns-r r -fa-� .4r.A:, -rpt A"» �l <br /> Show sketch or refer to attached Drawing Official Use Only <br /> 4n""Prch: 7PAwI�S Base Permit Fee $ IZ .iIU <br /> Additional Footage Fr(ee�e��{{���� $ \\`l�` A <br /> Misc. WN <br /> G 1Wj,- $ lVV.U� <br /> Misc. `1 $ <br /> Misc. S $ t�r(Fbr� <br /> Total $ <br /> Special Conditions: <br /> 4M� 0SPSL)7tt� f Cly 5 56 1 <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 /> 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,PERMITTEE SHALL CALL INSPECTIONS AT(209)9378381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br /> SIGNING. PrintQ�oti U V(tiW <br />