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Permit Number <br /> I <br /> CITYOF ENCROACHMENT PERMIT N2 77741 <br /> iSTOCKTON ON PUBLIC RIGHT-OF-WAY <br /> t ^ '{ APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant:��N,sN TJ+y.(oNMU.��{ ur �,,Tu, -Date: <br /> ubject to the General Provisions and Special Conditions,and all work mus <br /> Q;conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: he most current version of the City of Stockton Storm Water <br /> 'r1 Pollution Prevention Maintenance Staff Guide,whichever Is applicable. <br /> City: V I\ State: ZIP: -S a'? d, <br /> LL+By: ,I\1 �1" Date: 4 1 { 1 <br /> Phone: <br /> �fiSX YZ. Lo/h 5 <br /> 7f�U• h�q- 3f,v.1 E-mail: 00) .- p <br /> ssociated Permit(s): Expiration: <br /> WORKLOCATION: S rr, nn Lill <br /> r "N Wvnf,,! •wi,u• rl <br /> 1 - �. �r�arca Sf. S��jc��. C.,) 'ts�nu�B Lr S �'�;wLn: <br /> ��,py 1' r <br /> Start Date: Completion Date: 12 �L M. y -5 t�Y( rY A C( f , <br /> ;.f_��+.t°r�k.t,„ wo()��Lei' 1111,a- t:�'s. RI KA R <br /> ATTENTION:Applicant/Contractor you are responsible to replace all broken,damaged, EXMi(V?•2 H(-*JAB K 11T,-16`644 <br /> t6 644 U'ymv Y <br /> and/or raised sidewalk,curb and gutter frown score mark to score mark adjacent to the Ir fi <br /> parcel;remove USA markings upon completion of the permitted work. a WL <br /> Ut -- <br /> I(or we)hereby apply for an Encroachment Permit to carry out <br /> the following work: l� <br /> E,w6llt 2 .,,-AVS in J,N � alk bN S, *111- it yr (a,vel C7'✓ S�c�VI <br /> r <br /> All b? <br /> 'cam i-l)� �C S . FL 1�orc�cjo <br /> Show sketch or refer to attached Drawing <br /> Official Use Oniy�, <br /> [lase Permit Fee $ <br /> Additional Footage Fee $ <br /> M isc. (YI $ <br /> Misc. $ {ll• �a <br /> M isc. <br /> Total <br /> `�- Special Conditions: <br /> nnv <br /> 70 9 (039' 2�Z <br /> J <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, <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br /> SIGNING. Print A rJ,�7 <br /> Q S0A/ � �0NG{ /1� <br />