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F'11CROACHMENT PER "'T Permit Number <br /> CY OF o <br /> STOCKTON ~ ON PUBLIC RIGHT-OF-WAY <br /> N 77262 <br /> 6 <br /> IT <br /> P..,avfxs (t-AUauabo`_� it Prol�t,'F� <br /> A � oy a Sr�`1 D Zcj 1 } APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant:_ 110Y1 �N� �S Date: �, <br /> A ubject to the General Provisions and Special Conditions,and all work mus <br /> Address: ■�"� TY,G� l; y �m(� Still�, -0 onform to the project's approved Storm Water Pollution Prevention Plan o <br /> cn he most current version of the City of Stockton Storm Water <br /> n�/Ufj����1 �1 ollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> qI City: �an+Lyry Qr State: _ZIP: V � '�{r <br /> Phone: , By:_l ��1 Date: J <br /> -[ f�J E-mail: <br /> t�� ssociated Permit(s): Expiration: 1 1 1 <br /> Law Wei CA-CW V_A( <br /> WORK LOCATION: yym. A <br /> tart Date: ufACompletion Date: 1 � �� �e ISP nr <br /> . .�. <br /> CALL (209) 037-13355 TO REQUEST A C 4TM <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, NUW&ER NO LESS THAN 24 HOURS, BUT NOT IN <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the EXCESS OF 72 HOURS PRIOR TO START OF WOFiK <br /> parcel;remove USA markings upon completion of the permitted work. C I <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> SA& <br /> k�w,1_ -0&0a> S��n � rcl c�►�s . W�-Shote � <br /> S o}w sketch or reefer to attached Drawing <br /> Base Permit Fee 3,v0 <br /> Additional Footage Fee $ <br /> Misc. ��1 $ 3�.2 <br /> Misc. S $ to.�6 <br /> Misc. $ <br /> Total $ <br /> MAY 2 3 2014 Special Conditions: <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 /> OF 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)937.8381. /�, 1^1/ 1y► <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE Print U` S'�li(t5�.> V r <br /> SIGNING. <br />