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I _ h <br /> TTY OF STOCKTON <br /> Wt3RlN5 DEPARTMENT 75471 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br />' Applicant's (Jame <br /> ATC- A`60-IA IES INC. Date L3 /Z APPROVED: BY THE P WORKS-DIRECTOR <br /> (Owner/Contractor) �CyZ J � d0 Subject to the General Provisions and Special Conditions, <br /> Address_C,(,et)�. �-edS�€W4. <br /> Z- OQQ4 ne and all work must conform to the project's approved Storm <br /> City FL;AZAkr7stJ - State CA Zip *SR3 Water Pollution Prevention Plan or the most current version <br /> S1RC d �.Sc'EQRtAthc.� (Mc of the City of Stockton Storm Water Pollution Prevention <br /> Location of Proposed Work, etc. t' Mainte ce Staff Guide, whichever is applicable. <br /> NFc,CL w 6 MAI;z1WeR S ,AKtUE <br /> � ( � £t- t `s1 BY e <br /> %Owe /COotatrectorAddressm __a <br /> Estimated Starting Date 5/7,1117- Completion Date r �7!N1-,11lz Permit Expiration Date �� C-- <br /> I (or We) hereb apply for an Encroachment Permit to carry out the following work: <br /> PP�PEP+ /i6ANJ [�(t r <br /> pN�u� Q�II CCtcif iii SRi F1k Nt YoRI1JG GAG �� AS D.tA&-TQ I" AigfaCH6I R,66vt�PA— <br /> �E-rt�fL. <br /> i� 6r <br /> CZ3 _ <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; 'rip- /_ . ? q 3 <br /> remove USA markings upon completion of the permitted work. �AgUytjgpaj..Epgtag Com` ,r �.. $ .7 <br /> The above named applicant hereby requests permission to:.'r , <br /> �� <br /> ' a:. $Ev7CCr Tarp"�C(705'rC........... ..... Q <br /> ry TOTAL DEPOSIT ...... $ 5R Z 1 <br /> C Building Permit No. <br /> - Improvement Plan No. <br /> Supplemental Conditions: <br /> CONTIROL NUMBER, <br /> 4" ALL (209) 937-8366-M REQUEST A CONTROL <br /> _ UNIBER NO LESS THAN 24 HOURS, BUT NOT IN <br /> XCESS OF 72 HOURS PRIOR TO START OF WOK <br /> I' 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, resolutions, <br /> Standards and Specifications currently in effect, and to pay to the City its actual cost for removal and proper replacement of anyitem which <br /> does not meet the above requirements. Failure to comply will because for revocation of this permit..Applicant agrees to indemnify 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)937-8361. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. <br /> � ... ry Signed: -I Phone: '/'�S`l✓�a1�J <br /> 91 ' <br />