Laserfiche WebLink
i <br /> S CITY OF STDEPART U c r <br /> PUBLIC WORKS DEPARTMENT �' v Ur— " <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Applicant's Name RAMAf-E ENVIRONI"IM Late TVUE SIZOOZ APPROVED: BY THE PUBLIC WORKS DIRECTOR <br /> (Owner/Contractor) ( y 16 ) Subject to the General Provisions and Special Conditions, and all <br /> Address Pic , 6 0 'K Z 9 Phone 3 5 t - 3 2 5 0 work must conform to the project's approved Storm Water Pollution <br /> city RA NC li 0 MVR 1 E TA state CA zip 9 S C O 3 Prevention Plan or the City of Stockton storm Water Pollution <br /> Prevention Maintenance tall Glide, whichever is applicable. <br /> Location of Proposed Work, etc. 13 O N . H V N T E R STRUT <br /> EAST SIDE SIDE WALK <br /> Owner/ Contractor Address f124Z E , SCOTTS AVEr STOChTON B Date +6 <br /> Estimating Starting Date TU LY 1111001 Completion Date TV LY 12A(damritExpiration Date <br /> I (or We) hereby apply for an Encroachment Permit to carry out the following work: <br /> INSTALL TWO (rROVNDWRTtR MONITORIN (r WELLS 19 GI'TY SIDtWALk 'rHt <br /> PVC MONITORINbr WEL1. 5 WILL 4E SEGVRED WITH 6 ' I1140 DIAMETEIA , FLVSIA - <br /> MOvNTLD ,-tRAFE1C - RATtb SKIRT 130XES THE SIDEWALK 5QVARES, WILL <br /> DF 5A it AND REMOVED , AND THt STREtT (307(9SWILL DE S6T IN CONCAtTt <br /> PaulzEO -ro REPLACE THE REKOYLI) S (WARES . <br /> The above named applicant hereby requests permission to - / Z G <br /> PERMIT FEE .. .......................... $ '�— <br /> Additional Footage Fee ............ $ <br /> SEE 511E PLAN ATTA CHEP Trench Fee ............. .................. $ <br /> Sewer Tap Deposit.................... $ <br /> ro <br /> TOTAL DEPOSIT ......... $ <br /> / 2 <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> a po &4C Ck 1,,S ayCQ PgilttlA <br /> �.I7/"drtS <br /> • <br /> E�c <br /> Show sketch above orreferto drawing submitted r-„ 1yrr / �k,sa�. / !/ 21 ( k aIMPORTANT: 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 does <br /> not meet the above requirements. Failure to comply will be cause for revocation of permit. Applicant agrees to indemnify and hold the City <br /> harmless against any and all losses, costs, or damages resulting from injury to persons, death of person or damage to property occurring at the site <br /> of, or as a result of, work to be performed under this permit. A certificate of Insurance shall be submitted to the City Risk Manager prior to issuance <br /> of this permit. <br /> PERMITTEE SHALL CALL (209) 937-6366 FOR A CONTROL NUMBER NO LESS THAN 24 HOURS, BUT NOT IN EXCESS OF 72 HOURS, <br /> PRIOR TO THE START OF WORK, AND PRIOR TO ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE SIDE OF THIS <br /> PERMIT. IF WORK DOES NOT BEGIN 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 <br /> SPECIFIC INSTRUCTIONS PRIOR TO THE BEGINNING OF ANY WORK.) <br /> READ GENERAL PROVISIONS ON REVERSE SIDE OF THIS <br /> PERMIT BEFORE SIGNING, u <br /> k Signed: J Phone: ( 91 0 35 <br /> • ist-Permittee (while) 2nd-Inspection (pink) 3rd-File (yellow) 4th-Finance (white) <br />