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CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> N° & 2300 <br /> Name.-_George Lechich Da,e January 20, 994 <br /> ' /caat`oc'orI P.O.Box 881 , Stockton <br /> Addre,s__-. - - Phone299-466,-5771 <br /> location of Proposed Work,etc. <br /> 901 (9.21) West Fremont St. APPROVED: DIRECTOR OF PUBLIC WORKS <br /> (Corner of W. Fremont & Stockton St.) b <br /> Wm. J. Hunter & Associates <br /> Owntr/Controctor Address.2220 I�--"��gt"&--}}rte—pQ�1:-dilt@}}�`gJ�'$�a " W/—Date <br /> Estimated Slart;ng Dafe�` Completion Date :�> r� r L -Permit Expiration Dote <br /> I (or Wel hereby apply for an encroachment permit to carry out the following work: Place a groundwater monitoring <br /> well in the sidewalk adiacent to Valley Showcase Property located at 921 West Fremont Street. <br /> 2 additional monitoring welly art- bei a n the prnPrty of Vall. Shgwcase. The 3 wells <br /> are for the pur ooie of determining it ' ggroundwa_ter is Coat ELM a to be <br /> preformg!d -under the supervision of Wm. T. Hunteran Associate-s- wir consul taut. <br /> The above named applicant hereby requests permission to • PERMIT FEE . _ S Z-0 <br /> Add+Hanoi Footooe Fee <br /> See Plate VIII attached for sketch sewer Top Deposit .. . .. ...... .. <br /> TOTAL DEPOSIT ....................... S O <br /> Building Permit No. <br /> Improvement Pian No. <br /> Supplemental Conditions: <br /> Show sketch above or refer to drawing submitted <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, <br /> resolutions, standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replace- <br /> ment of any item which does not meet above requirements, Failure to comply will be cause for revocation of permit. Appli- <br /> cant agrees -to indemnify and hold the City harmless against any and all losses, costs, or damages resulting from injury to <br /> persons, death of person or damage to property occurring at the site of or as a result of work to be performed under this <br /> permit. Certificate of insurance will be presented by applicant upon request. <br /> Road General Provisions on reverse side of this permit before signing. •Nota requirement of notifications and Inspections. <br /> Permit Engineetrllnspeetor <br /> 944-8!256- <br /> 9"41;$ft Signed: Phone 60 15' 21 <br /> C)3 --e4 It <br /> r C 4-L.4- FV& 601UTWL Ou m lDj L 24 gout�6 t/i 0 Ufa ve-6— <br /> Ist—Permittee 2rx4--*ile ]rd—F nonce Itt—utrlity/Street <br />