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APP--24-199 ' 11' 119 FRi�1�1 -.S-HOVATO � TO 1 'C��54C11381�1�� P.02 <br /> CITY OF STOCKTON <br /> DEPARTMENT of PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> 61698 <br /> 7.5S <br /> Aapiicent's tidrne._ <br /> I 'Z1111mtoor) <br /> Add ress �a1.- .13F.kY �.�—Phanc� � 31 - <br /> 9,+g4 - ' APP QVEtl: DIRECTOR OF PUBLIC. WORKS <br /> ZCGOyinrt vi Pro?r„sed work.etc-A� '€—_ 1 <br /> �+rY!Erl�Mtr9�3r,SQiy'aBS�. —-- - 8y <br /> L�o!� ate <br /> Cor*otieryon bQtrmi4�Cxl?i ratipfl bat! <br /> Estimated Startr-� <br /> , �,iy for anti ertGraCchrrryenf porn i• to carry out the fallOwl n work: eL2�3'� <br /> 'Mo ai?aVe norr'ed ooPiitont hereby (4gQvt t 1510rmrssi6n 10- PERMNI FSE...... � <br /> Sewee Top Npasif , <br /> J <br /> TOTAL DEPOSIT .............::...... <br /> .: <br /> I <br /> Building Permit No. _ <br /> Improvement Pian No. �-�--�- <br /> Supplemental Conditions: <br /> Show skatch obove or refer to drawing suhmined <br /> , s <br /> IMPORTANT: Applicant hereby agrees to comply with oil previsions of this permit as welt as all applico`dle City ordinances, <br /> resolutions., stondors:ls and specifications currently in effect, acrd to pay to City its actual cost for removal and proper reploce- <br /> enent of any iterr� whir–h does not meet obove requirementx. Failure to comply will bA couse for revocation of permit. Appli- <br /> Gent agrees to 1rrdem€ ;fy and hold the C;ty harmless against any and oil losses, costs, or-damoge! resulting from injury to <br /> persons; deoth 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 /> Beed General Provisions an revorsb sidh of this permit before signing. 'Note requirement of notifications and inspections, <br /> Pdrrnit Engineerllnspoctor <br /> 944-8254 <br /> 9"-8366 Signed. Phone. _ rr <br /> 13t--.+�lrmitlW 7r�..'filr 3rd—�,rrpntt �tY+'-'-Ut{rirYlSlrNrt j! <br />