Laserfiche WebLink
• CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS 65,428 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Applicant's Name a Su � Date 7 / ' <br /> (Owner/Contractor) G <br /> Address377<Shle- Ok&S' C Phone�S/ `� <br /> / APPROVED: PUBLIC WORKS DIRT bTOR <br /> ! <br /> City a �t State Zip <br /> Location of Proposed Work,eta. <br /> Sve(,E;Z'n,cl One- GP6' G'cG Sr- <br /> Owner/Contractor Address 372 GL-4 L�,�iYG r��_f G� By Date <br /> Estimating Starting Date ZZ2-7-/ 99 Completion Date Permit Expiration Date Z <br /> I (or We) hereby apply for an enroachment permit to carry out the following work: <br /> p The above named applicant hereby requests permission to- <br /> i'l Oti.� CP� 4c,-;-, PERMIT FEE..........................................$ <br /> f o, 7 /9L f'/�9 a� <br /> Additional Footage Fee...........................$ <br /> RC-0 xg Z/�,_ Sewer Tap Deposit................................. <br /> %SQe /TG� �i'�.C1( TOTAL DEPOSIT.............$ ! 2 r <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> aide alt tares -Skau Ise, b/ 3,co . <br /> a f � '11 Slr�al� cove. c.u: <br /> C`i� o� ��c1C�►� S�a��elr� S�t��ca�� <br /> Show sketch above or refer to drawing submitted <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 (1-800-642-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES, <br /> PERMITTEE SHALL CALL (209)937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. _ <br /> Read General Provisions on revers6 side of thi�pe �'tefore sig g - Note requirement of notifications and inspections. <br /> Signed: Phone: f u 1/ <br /> 3rd-Finance I <br /> > 41h-Utility/Street <br />