Laserfiche WebLink
CROACHMENT PERN�f••T Permit Number <br /> �CITYOF nlD� r — 7 °rTcoz <br /> �STOCKTON ON PUBLIC RIGHT-OF-WAY EFpl -0445 <br /> Applicant: Co n do r (SIS 1 l eck, a Date: 311511 - > APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Q j�/� '' ^ Z Subject to the General Provisions and Special Conditions,and all work mus <br /> / / n Y1 t"'/L�Sr�I • ��--r T conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: r f c vv +• he most current version of the City of Stockton Storm Wate <br /> /� Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: ��jj��Sr%l CC l .�✓� State: CA ZIP: �152T Q <br /> PhoneI /.IJ —IO/7y E-mail: �GO''J O ey MarkDale: <br /> 3A/ "/11 ssociated Permit(s): Expiration: <br /> WORK LOCATION: 2 ZLJ VV + <br /> /^7 99'� L� / 1111 D e�t'!171HOtiT A <br /> Start Dale: (1, I I ' . . �� Completion Date: <br /> 114, <br /> ,r' La_ It CONTROL NUMBER <br /> , <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, C.SLL (2N) W174.366 TO REQUEST A CON fI cj�l}7r�G GR =�i f i e�� s, �- <br /> and/orraised sidewalk,curb and utter from score mark to score mark + i�:VN24 KILIIRaS, BUT NOT IN <br /> g EXCESS r3F 72 HOURS PROP TO ST <br /> parcel;remove USA markings upon completion of the permitted work. CONTR « ` :IRT OF� Yi. <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> 'to rJ(III Ictnr soil bc,I 'I ne;A b0LA11 <br /> <1zle5 -� jlli ``c' `2WiS PriVe-- ihe-A b�Yc_tiIflI w; A <�n12rT �u1� �a�c/zT� <br /> Show sketch or refer to attached Drawing <br /> Official Use Only <br /> r 0ITC-,terdrirkt4/1 u- s <br /> r (� Q ] J Base Permit Fee $ 52-15. 00 <br /> T I o cc,T- <br /> C"Y) S♦ (3 13 Z%, 33 B3 Additional Footage Fee $ <br /> Misc. _MM $ 3q.23 <br /> 9>n ri)kg � i ck y rc, ✓1�� �i� � T1'•Ct�l ' � Misc. CIS $ ;31 . ;jg <br /> J p Misc. $ <br /> Total s593.101 <br /> Special Conditions: <br /> For ih4i cm eA(L Tado►t Est ' <br /> Q,t � -(039 -1282 <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, Standards anc <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 anc <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 ANEW CONTROL NUMBER. PRIORTO 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. Print I l r <br />