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CKTON
<br /> N CITY OF STDEPART
<br /> PUBLIC WORKS DEPARTMENT 7 1 9 9 7
<br /> MM15 APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY
<br />'I
<br />!! Applicant's Name Ie4fi t�Q7 tty W Date � � O APPROVED : BY THE PUBLIC WORKS DIRECTOR
<br /> (Owner/Contractor))�
<br /> Address 2.z PreAk6Lor At-(. Phone 5100 307 Iq
<br /> Subject to the General Provisions and Special Conditions,
<br /> /� /f y and all work must conform to the project's approved Storm
<br /> City PrQn�' R , L" iM 00'1 State CA Zip 780 Water Pollution Prevention Plan or the most current version
<br /> f IA Ine 1 of the City of Stockton Storm Water Pollution Prevention
<br /> Location of Proposed Work , etc. NOrwA 60uhj _ II a'�li Maintenance Staff Guide, whichever is applicable .
<br /> t2S✓10 V� A+ L Vpi.IN D :_ btlwrl. W, g=k W . Ga� �l�l/(�(��>%Z��/' � Z�
<br /> Owner/Contractor Address 113 1 7 SOUT reKrIO \1e • By Date !
<br /> Estimated Starting Date S b O $ Completion Date 5 O8 Permit Expiration Date -� J d
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<br /> I (or We) hereby a ply for an Encroachment Permit to carry out the following work: GO I e T' ouT'
<br />;i r � So boon S 4^o q pq f o)( iY4e% l 2O Pee.+ n or er
<br /> jnVer> + igCk +ioyr) worrk 0, SSocia4e w . }1t S" JM L4;h C (2)LAV)
<br /> nv, vt � til Negl �� DeNNH- Y*ee4 ' LUST ea Se 14250c,
<br /> ATTENTION: Applicant/Contractor — you are responsible to
<br /> replace all broken , damaged, and/or raised sidewalk, curb and PERMIT FEE . . . . . . . . . .. . . . . .. . . . . . . . . . . $
<br /> gutter from score mark to score mark adjacent to the parcel;
<br /> remove USA markings upon completion of the permitted work. Additional Footage Fee . . , . . , . , , , $
<br /> The above named applicant hereby requests permission to
<br /> a�
<br /> Sewer Tap Deposit ., , , , , ' , , P1 . 1 . 114 , $
<br /> See
<br /> ;:T
<br /> See '�TMVc �cm
<br /> I/ j
<br /> + TOTAL DEPOSIT . . . . . . $
<br /> A foo c ed. Building Permit No.
<br /> Improvement Plan No.
<br /> Su plemental C9� ditions:
<br /> SG� rn I I � I� S, StI [Spof dry She, / / be /ace• F' "n
<br /> Hp S C oP/� D
<br /> PrioPto1Joe krAl roe dAvnS y1neJf% tt&ke "/'
<br /> ��tw - 3pryl 51,nlf obt"r � tie own
<br /> PERMIT N T VALID WIT OUT A
<br /> CONTROLNUMSER.
<br /> CALL (209) 9374M TO REQUEST A CONTROL
<br /> NUMBER NO LESS THAN 24 HOURS, BUT NOT IN
<br /> EXCESS OF 72 HOURS PRIOR TO START OF VMRK.
<br /> Show sketch above or refer to drawing submitted CONTpAI 7d
<br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions,
<br /> Standards and Specifications currently in effect, and to pay to the City its actual cost for removal and proper replacement of any Item which
<br /> does not meet the above requirements. Failure to comply will be cause for revocation of this permit. Applicant agrees to indemnity and hold
<br /> the City harmless against any and all losses, costs, or damages resulting from injury to persons, death of person or damage to property
<br /> occurring at the site of, or as a result of, work to be performed under this permit. A certificate of insurance shall be submitted to the City Risk
<br /> Manager prior to issuance of this permit.
<br /> IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE OF A CONTROL NUMBER, THE CONTROL NUMBER WILL
<br /> BECOME INVALID AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. (FOR CAPITAL IMPROVEMENT PROJECTS OR
<br /> SUBDIVISION IMPROVEMENTS, PERMITTEE SHALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT (209) 937.8411 FOR SPECIFIC
<br /> INSTRUCTIONS PRIOR TO THE BEGINNING OF ANY WORK.) PRIOR TO ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE
<br /> SIDE OF THIS PERMIT, PERMITTEE SHALL CALL (209) 937.8381 .
<br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING.
<br /> Signed: vis 0- Phone: SIC 3�7 91 3
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