Laserfiche WebLink
CITY OF STOCKTON <br />DEPARTMENT OF PUBLIC WORKS WAO <br />APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT -0 <br />Fly 95 <br />Applicant's Name e,= Date . p 7 5 -2:9 <br />lowrpsi Ir, tractor) <br />Addres{ d:F _Y, 1� �f� _ - - - Phone <br />r. ! APPROVED: DIRECTOR OF PUBLIC WORKS <br />Location of Proposed Work, etc i/t <br />g-- g:nn,-fie-r <br />Owner/Contractor A5LBy Date / <br />�t 10 CG 1. l Z 1 Q 1�1 �� Z �PFrmit Er //— / — ! � <br />Estimated Start' g Date_ Co tion D e pirofian Dote S.b.- <br />I (or We) hereby apply for on encroachment permit to carry out the following work:_ <br />T e n "o <br />The alcove named applicant hereby requests permission to - <br />Ayl 0 <br />(Zoq) / C <br />�g`f—kz-2� <br />Show sketch above of refer to drawing submined <br />PERMIT FEE ...... ................................ ,.... .... <br />Additional Footage Fee,_. <br />Sewer Tap Deposit .................................... <br />TOTAL DEPOSIT <br />Building Permit No. <br />Improvement Plan No. <br />Supplemental Conditions: /] <br />. i 72 e.�cQ �-�C <br />IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, <br />resolutions, standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replace- <br />ment of any item which does not meet above requirements. Foilvre to comply will be cause for revocation of permit. Appli- <br />cant agrees to indemnify and hold the City harmless against any and all losses, costs, or damages resulting from injury to <br />persons, death of person or damage to property occurring at the site of or as a result of work to be performed under this <br />permit. Certificate of insurance will be presented by applicant upon request. <br />Rad General Provisions on reverse side of this permit before signing. *Note requirement of notifications and inspections. . <br />0 Permit Engineer/ Inspector <br />944-6250 <br />944.8366 Signs 1 Phan <br />RCCEIVED SEP 2 2 ?c,v1 <br />