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SEP-07-2000 15 : 15 _ _ PUBLIC WORKS PERMIT CENTR 209 937 8901 P . 01 <br /> r3 � <br /> CITY OF STOCKTON <br /> DEPARTMMT of PUBLIC WORKS 6 S w <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHr•OF•WAY .� Z <br /> AF Wallace - vuh ( 7 /t5soc . (v1c . Oa070A � <br /> a�d a Noma W;F:Ar � ,mw � t 7lb�ate A7100 w � <br /> Irori>:ontracta [ � I b� 3.73 — w <br /> AEC M 1011 t`�. _S7a a:kz:: ` __Y.__.____._. phone # <br /> City 5: kOL4aTkzzn surto ._�.1� ZIP g. ._._ APPROVED: PUBLIC WORKS DIRECTOR <br /> tncaUaa of Propound Waris, atc: ! ,? ... ref"-S'- r925&y;t 2 -r n �CIn U '.. <br /> OwnW Cmtranar Ad09aG , �"" ' - -_'�� - ware � �7 O � 3 <br /> Esematbq Swoing Dote Q�2 i y-�o c uetmn Date 1 Z �y J PemtR F rarbn Dau 2� 0 b �j ',,.. <br /> 1 (or We) hereby apply for an enrvachment permit to carry mut the following work �' — - ego <br /> r a7N iA ti V <br /> ung <br /> n* 4ban weed swU t 410 mqa pwm wm • 4V <br /> PFIiFN-r FEE ............__.......................... a <br /> 0 M Sewer Tap Deposit,-"......... .............. /1 t� <br /> I., fT . '_ . — a •�— ~ TOTAL DEPOSIT .....-. S <br /> �.GlBuilding Permit No. <br /> /// Mw� Improvement Plan No, <br /> ` � k0IFF! W FA�l vt, ` Supplemental Conditions: <br /> vvm, 11Dur5 orl j=(604vv1� 5r , llwirteA <br /> 1"D J° a , ro . FGtrll 3F. m . <br /> fz(fPUOCAbIf� R�rrvt 0t 00 - I - <br /> 1� '7:Qapvst�+ u74�tt etxer�en� <br /> IMPORTANT: Applicant hereby agrees to Comply with all provisions of this permit as wall as all appiicaMe City ordhtances, resolutions, <br /> standards and specHksttlona c un,6ntly in effect, and to pay to Cay its actual coat for removal and proper replacement of any item which <br /> does not meet above requiremer;ts. Failure to comply will be cause for revocation of permit, Applicant agrees t0 indemnify and hold the <br /> City harmless against any and all losses, costa, or damages resulting from injury to parsons, death of person or damage to property <br /> oecuring at the site of, or as a It ef, work to be performed under this permit A cortificme of insurance shall be submitted to the City <br /> Alsk Manager prior to beginning con0mcition, <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1 -90U Q%2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUNQ UTILMES, <br /> PERMMEE SHALL CALL (209) 937 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. gap <br /> Read General Provisions on reverse side of this /a it re gning - Nota requiremene of not4icati�rts� and inspections, <br /> lrtrermmee -Fla ar6FMwee ah•UNNiSien <br /> TOTAL P . 01 <br />