Laserfiche WebLink
Milt <br /> CITY OF STOCKTON OCT 2 6 1993 <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY F.NVIRONMENIAL HEALTH <br /> G0MITI,SE,(2YJ1A <br /> ,^�f A 0D GG LL ^J� yy <br /> Applicant's Name KWrV D I Dote n <br /> •T � 3 <br /> ,owner/contro< © D l 3 3 I <br /> •�6 <br /> � - S2 O <br /> AddressYYC phone9tb B <br /> � e nm I � <br /> Location of Proposed Work, etc - O/ T EI DGra.do Si%feG�� APPROVED: DIRECTOR OF PUBLIC WORKS <br /> r Address Samir BY–L� { �— /�� F Dateil `Z6 <br /> Estimated StartingDote oetion Date 'y���yQ'�om`- J'—L;p Permit Expiration Date <br /> fr�Pf �I�l ,L-/ (-7h p <br /> �d�f(�/D 3Q- <br /> I (or Wel hereby apply for an encroctchment permit to c rryy ouIh a following wor : P_ir / l and 14S7,0117,400 <br /> i <br /> The above named applicant hereby req vests Permission to PERMIT FEE . ... . .. . ... .. . . ... . . . ... . . .. ... ... .. .. . . .. . ... 3 <br /> gAdditional Footage Fee. . . .. . .... . _. .. . . . . . . .. . .. <br /> Iii D Sewer Tap Deposit .... . . .. .... ... <br /> / ^ TOTAL DEPOSIT ..... ...... ............ . $ <br /> See P + CL C Z Building Permit No . <br /> Improvement Plan No. <br /> Supplemental Conditions : <br /> ULL �72rt/—`f/ G FLOW 6y 3 , �5e3dM <br /> ci' d /f r <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, <br /> resolutions, standards and specificatipns currently in effect, and to pay to City its actual cost for removal and proper replace- <br /> ment of any item which does not meet above requirements. Failure to comply will be cause for revocation of permit. Appli - <br /> cant agrees to indemnify and hold the City harmless against any and all losses, costs, .or damages resulting from injury to <br /> persons, death 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 /> Reed General Provlslons on reverse Aide of this permit before signing. ' Note requirement of notifications and Inspections. <br /> Permit �nglnearlInspector <br /> 444C.� /C 9i6 - 8S1-(odrla <br /> 944838086 signed: phone <br /> >r <br /> 10-4ermhtee 2nd—file 3rd—nnance 4th­UtllitY/Street <br />