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i <br /> CIN OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-O&WAY 57912 <br /> J <br /> Tnl1't/RR - <br /> T ;an coo SvsSPs — e° ate"`1e14F _240 <br /> Avii µ' APPROVED: DIRECTOR OF PUBLIC WORKS <br /> Fremont Pte• ��--"� <br /> Mission Blvd & <br /> r•�`°3 of Pacific A e <br /> wart,etc N•W• Corner y� <br /> lawtion o1 PropoMd !� pate .G' <br /> Marc a <br /> same as above <br /> p.ner/aonlracNr ApNtu 7 <br /> _Pe.mlt Er Pirohan DaN <br /> 11 0-8 <br /> poN <br /> 10-16-88 paNr `�- <br /> Ell d S ninework: <br /> I (or Wel hereby apply for on encroachment permit to carry out the following <br /> I nnd the 110-IE-1 <br /> Excavate 2" diameter bot h <br /> a roximatel 25' -3101 below r <br /> immediate) backfilled a in <br /> attached sketch. <br /> 50 00 <br /> ryrmiulrn to- <br /> PERMIT FEE ... ....._.. <br /> . . <br /> S <br /> r atls <br /> Tbe above named api iimnt horsily equ <br /> Aeenwrai Faotaae he._.- -.. ............... <br /> Backfill of holes to be as follows: <br /> Stover Top papwlt ... _................... . <br /> (1 ) Bentonite pellets or concrete grout 50 00 <br /> to top of native soil . <br /> TOTAL DEPOSIT ........................ S <br /> (2) Concrete grout to within 4" of lBuilding Permit No. <br /> pavement surface. Improvement Plan No. <br /> (3) Asphalt Concrete to existing pavement Supplemental Conditions; <br /> surface. <br /> Notify Underground Service Alert 48 hours <br /> prior to work. <br /> Work to be performed on a Sunday morning, <br /> Show .ketch about Of refer to drawir+g mhmltted <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinance <br /> standards and specifications currently in effect, and to pay to City Its actual cost for removat and proper replac <br /> resolutions, equiremenitem which does not meet above rts. Failure to comply will be cause for revocation of permit. App <br /> ment any <br /> against the ane of aro asscosts, <br /> a eod <br /> result of work to s bespe <br /> cant agrees to indemnify and hold the City harmless <br /> rform d under t <br /> persons, death of person or damage to property g <br /> permit. Certificate of insurance will be presented by applicant upon request. <br /> Read General Provisions on reverse side of this permit before signing. 'Note requirement of notifications and Inspections. <br /> Permit Engineer/Inspector � <br /> 9448492 <br /> 944.8366 <br /> -3 f <br /> t+r�•rmrtra. 2n0—file Jra—rironce Irh--unhry/S++ser .lip G1.�Z.' <br />