Laserfiche WebLink
CITY OF STOCKTON I'm4w <br /> ... PUBLIC WORKS DEPARTMENT JAN 0 7 2010 5 73451 <br /> 1 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF <br /> M05 EON <br /> .-._NpT LHEaL� <br /> Applicant' Name PSC Industrial outsourcing, LP Date 12/10/2009 APPROVED: BYTHR I(SM DIRECTOR <br /> (Owner ntracfor <br /> Address 210 Sand Bank Road Phone 616-281-1543 Subject to the General Provisions and Special Conditions, <br /> and all work must conform to the project's approved Storm <br /> City Columbia State I L Zip 62236 Water Pollution Prevention Plan or the most current version <br /> Location of Proposed Work, etc. I n front of: of the City of Stockton Storm Water Pollution Prevention <br /> P Mainte Staff Guide, whichev is applicable. <br /> 1717 South Center Street, Stockton i <br /> >r <br /> Owner/Contractor Address Same By Date <br /> Estimated Starting Date 1/14/2010 Completion Date 2-3 days Permit Expiration Date 3��s <br /> 1 (or We) hereby apply for an Encroachment Permit to carry out the following work: Start date is estimated but not finalized <br /> at this time due to various permit aoproyals. PSC will conduct 3 CPT borinag to identify orolindwater hearing <br /> zones and then collect groundwater samples from adjacent borings for laboratory analyses The approximate total <br /> depth will be 55-90 feet below aroLInd surface for each of the 3 inve.Ojoatjon lonatinns <br /> Ol 3 . 3"*zi IZZA- <br /> ATTENTION: ApplicanVContractor—you are responsible to 5 Z <br /> replace all broken, damaged, and/or raised sidewalk, curb and PERMIT FEE. ......................... $ <br /> gutter from score mark to score mark adjacent to the parcel; <br /> remove USA markings upon completion of the permitted work. { $ / <br /> The above named applicant hereby requests permission to: � ........... /© 116 <br /> See attached figure. <br /> TOTAL DEPOSIT ...... $ <br /> Building Permit No. AIA NA <br /> 575 �5 <br /> Improvement Plan No. tit NA <br /> Supplemental Conditions: ah <br /> o n t e5 (1af/ <br /> PERMIT NOT VAUD wrmoU Awe <br /> CONTROL NUMBER. <br /> CALL (209) 937.8366 TO REQUEST A CONTROL <br /> NUMBER NO LESS THAN 24 HOURS, BUT NOT IN <br /> EXCESS OF 72 HOURS PRIOR TO START OF WORK. <br /> CONTROL# <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 the City its actual cost for removal and proper replacement of any item which <br /> does not meet the above requirements. Failure to comply will be cause for revocation of this permit.Applicant agrees to indemnify and hold <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. (ATTACHED) <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)937-8411 FOR SPECIFIC <br /> INSTRUCTIONS PRIOR TO THE BEGINNING OF ANY WORK.)PRIOR TO ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE <br /> SIDE OF THIS PERMIT,PERMITTEE SHALL CALL(209)937-8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. <br /> Signed: C Phone: 618-406-0823 <br /> T <br /> 1st _Pormittpp (white) 91d -Incnprtinn (nink) — Aid-Fila lvallnwl 41h -Finance (white.) r <br />