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C,T't OF STOCK —i CN <br /> DEPARTMENT OF PUBL1C 'NORKS <br /> APPLICATION FOR ENCROACHME'4T ON PUBLIC RIGHT-OF-,tiA't <br /> ~�► <br /> AoRlicanl s Name ��t.,.�I.Jt, � � -��•� �Lr1C-_ Dara <br /> (OwrerlContracrar) 'E �3C � <br /> , <br /> Address <br /> Szt 3 r cc 1J-t C Phan .3_-[h i <br /> '' - <br /> �ryAPDROVED PUBLIC `NO=t<S DIRECTOR <br /> Cty Stare Zo r JLC J <br /> f , L <br /> t-ecattonof P oPcsad'.Vorc etc -art 1 e, r C z t-1v1 LK—,,7 <br /> Owner/Contrac,arAcdress ��� �- ._ , �j <br /> Estimating Starting Date _ YL� _ 1 z�C� Cc^c a cn Date�Z 4� U r�+� Parma Exolrauo- Ca a - ^ <br /> r� <br /> I (or We) hereby apply for an en.cacnrnent cermet tq carry out tl'e folic ring rrcrk �L� 5 l-,,, Ic.�[.' r " C 71 <br /> A. [� `�1� .lit( i 't� �Ll 4L� '41 <br /> t 3 r r <br /> X0 5 <br /> Tie aeove namefl=hoar -9reev ec-es s cermission to -- - <br /> ( P=_:i'riiT F�� <br /> A=ttoral Footage Fee _ <br /> . Serer Tao Deposit <br /> TOTAL DEPOSIT 3 <br /> Building Permit No <br /> Improvement Plan No <br /> A <br /> Suoplemenlat Conditions <br /> � , <br /> K , <br /> Show sketch aoo�e or rater to drawKng suurnmed ' <br /> IMPORTANT Applicant hereby agrees to comply with all provisions of this permit as well as all applicaole C.ty ordinances, resolutic <br /> standards and specifications currently in e-fect, and to pay to City Its actual cost for removal and proper remacement of any Item wh <br /> does not meet above requirements Failure to comply will be cause for revocation of permit Applicant agrees .o indemnify and hold <br /> City harmless against any and all losses costs, or damages resulting from injury to persons, death of person or damage to propE <br /> occunng at the site of, or as a result of work to be performed under this permit A certificate of insurance snail be submitted to the C <br /> Risk Manager prior to beginning construction <br /> ERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1-500-642-2444) TWO WORKING DAYS BEFORE BEGINNI <br /> WRK FOR LOCATION OF UNDERGROUND UTILITIES <br /> PERMITTEE SHALL CALL(209) 937-�4 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEOL <br /> INSPECTION <br /> Read General Provisions on reverse side of this permit before signing - Note requirement of notrficabons and inspectic <br />