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T� CITY OF STOCKTON 76574.
<br /> CD +VBL-tC--W@RKS-DEPARTMENT
<br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT OF-WAY
<br /> M5CD
<br /> Applicant's Name r�re99 �t i j in4 Tey tln4 Date �y APPROVED: BY THE PUBt[CMORKS DIRECTOR
<br /> (Owner/Contractor) — JT
<br /> Address ru# Ave, Phone 7.25'38 -S$Uo Subject to the General Provisions and Special Conditions,
<br /> and all work must conform to the project's approved Storm
<br /> City 514ngl State C_ A __Zip 70465-Its Water Pollution Prevention Plan or the most current version
<br /> of the City of Stockton Storm Water Pollution Prevention
<br /> Location of Proposed Work,etc. $00 W "UrLL is& , rNea,_ Maintenance Staff Guide,whichever is applicable.
<br /> Jn4trSBC:l',6, 4 aurA —S+ 4nd S. Sqn J6s 5fi `r �t
<br /> Owner/Contractor Address See q bove, By-W t w� V,1 O,SO Date
<br /> Estimated Starting Date '29 JL41v )01,:; Completion Date -:) �c_} 0O!i Permit Expiration Date
<br /> I (or We)hereby apply for an Encroachment Permit to carry out the following work:
<br /> tone &�,e_+rat�tQ 1 k -i-ih� CCPT) aid �ydf.�a��L, �rou�dwg�e.- S�rMAII.-►A at ��,o ue �oc�%��,.
<br /> A+ � -Fn �Lsu.>,p� i,,+T q s�Ql/ las, rod �;// �e aa�yah�c:< usiur dirt D��
<br /> �C 4a / T J ,ro i,n, 57 -F' ;4 )�4D 3rl o rrnS L.4)",) /l n i
<br /> �n/�4),Je d in acea rdahGt W;41 LOlsH7y rG�l+/�Ch9Gn T3 7k/t9t4yidl w�C�ire d ia a cord ana
<br /> w-4� erhf �eq�jec+►,er,fs r
<br /> ATTENTION:Applicant/Contractor-you are responsible to
<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. P,4dltional.-Footage-Feee $ .
<br /> The above named applicant hereby requests permission to
<br /> Sew,gc,TDDS.. $
<br /> qc�. d TOTAL DEPOSIT ...... $ 57 l�
<br /> Building Permit No.
<br /> Improvement Plan No.
<br /> Supplemental Conditions:
<br /> .,,Y1y l�q �i• yVVYU Y1rC:✓l�l�,
<br /> kwl !i'l AV,
<br /> 9,17.= TO REWEST A MSI'::�
<br /> is • .•tk i':^dl.!'eY^ ea fir` .; •.�
<br /> WA-i
<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.
<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 /> 610•ags- a-4-40 tw)
<br /> Signed: L� Phone:
<br /> 151-Permittee(white) 2nd-Inspection(pink) 3rd-File(yellow) 4111-Finance(white)
<br />
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