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CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS 6 J 090 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> _ RDC E YED <br /> Applicant's Name oSE r 1t R A 1yl yl lr Date 11 3 00 <br /> (Owner/comrrtactor) CONSVITANT AGFN ( 916 ) NOV 2 8 2000 <br /> Address P. O . 13 0 X 2169 Phone <br /> city RANCHO MURIETA State CA Zip 3563 APPROVED: PUBLIC WORTWftTHEALTH <br /> Location of Proposed Work etc. <br /> S I D E wA L It AT PERMIT/SERVICES <br /> 130 N , HvNtER ST. I STockTON ( � <br /> Owner/ Contractor Address FMIA ENViRGNMENTAI ABY64 DateEstimating Starting Date 12 1 1 d r+ Completion Date i Z 1 it Expiration Date <br /> I (or We) hereby apply for an enroachment permit to carry out the following work: PRI L ( Z ) $ 0 I L b 0 ti 1 N (rS TO <br /> HovNDW' ATER ( N 35 EE15T DEEP ) FOR SOIL AND G- ROVNOWATFR SAWLING . <br /> SOIL 13ORING-5 WILL IiE DRILLED VJ iZH A GEDPROt 9, THE 13ORIN15- 5 WILL <br /> I) E 2 - lNLIiES IN DIAMETER . THEY WILL (3E SEALED WITH NEAT CEKI NT <br /> a CAGVT PLACED I�Y 'MEMIE0 ON TBE SANTE PAY TIiAT THkY ARE DRILLED . <br /> THE CONCRETE SURFACE WILL 13E RESTORED BY FLV51011 PAi NA <br /> PERMANENT WILL 5TRVCTVRt5 WILL RE % N5TALLEP . <br /> The above named applicant hereb Is ion to = l 1 Q (] <br /> pp yrequas permission <br /> PERMIT FEE .......................................... $ <br /> 5 Y C AIT A C 1i F D ` 16- U R F Z Additional Footage Fee ........................... $ <br /> Sewer Tap Deposit .................."I....I....... <br /> TOTAL DEPOSIT ............. $ 1 Z Z 00 <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> n� damago S't" v, s 11 !tee .c d <br /> 4JIrCC+eQ <br /> Show sketch above or rater 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 City its actual cost for removal and proper replacement of any item which <br /> does not meet above requirements. Failure to comply will be cause for revocation of permit. Applicant agrees to indemnify and hold the <br /> City harmless against any and all losses, costs, or damages resulting from injury to persons, death of person or damage to property <br /> occuring 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 <br /> Risk Manager prior to beginning construction. <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1 -800-642-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL (209) 937- io HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions on reverse side of this permit before signing - Note requirement of notifications and inspections. <br /> Signed:_ 1 — — 1 nn2"� a Phone: t 91 y ) 3 SJ —32 <br /> L S0 <br /> tsl-Permittee Znd-Filo 3rd-Finance 4th-1.1hlily/Street <br />