Laserfiche WebLink
07 / 31 / 01 TUE 16 : 08 FAX 1 916 . 861 0430 __, SECOR- SACRAMENTO 002 <br /> Jul 31 01 11 : 113 of StocktonPW - Permit t2G 337 - 89111 P . 2 <br /> CITY OF STOCKTON "u U L. <br /> Milli WORKS DEPARTMENT J U <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT•OFMAY <br /> Appplicant's Name �� <br /> r 9010A Cale �`�� `O/ APPROVEoi BY THE PUBLIC WORKS DIRECTOR <br /> (OwnorlGontrador) / Subject to the General Provisions and special Condlttons, and all <br /> AdtlroasO / ! �e/'e � o _ Phone �9/ E/ wade must coMorm to the projaers approved Storm Water Pollution <br /> �� a c-/ z� Prevention Plan or the City of Stockton Storm Water Pollution <br /> Clry 19-s'1S�-L���`ci nVe� Stag Zp - F Provenfon Malntonance Staff Guido, whichever Is applicable, <br /> Location of Proposed Work, arc. EAf Plus P <br /> A / � G o ✓rn S. c . _ <br /> //0 Jp L pr n [e !k L P1 7 3l <br /> M15 <br /> By Data <br /> Ovmerl Contractor Address <br /> estimating Starting Date 7 ?,: Complexion Data _� ZO - O / Permit 1:xpiraloo Date <br /> I (or We) hereby applY for an Encroachment Permit to carry out the following work: o(vanc/n , y C�fS <br /> ` ( n o, �, r - l boor l/ c t!'+�!Blr%ratnrt <br /> 'L� �J�" '.. 7 <br /> n7q 7 s�Q Yrin cP L a n <br /> nov �.irn �rlrs {�e� , ,�S °`fes—�GY)rnm �,✓ / /Ot -- <br /> Q�ackF% llP wifH vtro, t rav+rar 0. n .1 Finn /shPr� <br /> tl,i / in a <br /> 4if! w e tra ! s W ro nr din <br /> l2g F061 <br /> The ebon named pppllegnr bomb/ reQupms pe,MIe4IM b - PERMIT FEE ............................ $Additional Footage Fee 1111.... ... . S <br /> Trench Fee .1...... . ..00.1. 1.............. S <br /> eowar Tip Deposli.............. . . .... S --. <br /> _fes TOTAL OEPOSIT ........ . 5 V �O <br /> I / " `C• � � Building Permit No. <br /> Improvement Plan No- <br /> Supplemental COnditlOnS: <br /> Pe fJ o* cC, All <br /> show skskh cam ur rufur a m9wing submlbed <br /> IMPORTANT. Applicant hereby agrees to comply with all proveions of this permit, as well ole oil apPlicebla city ordinances, resolutions. <br /> Standards and Spacidmlicne currently In effect, and to pay to the City he actual cost for removal and propar replacement of any hem which does <br /> not moot the above requirements. Failure to comply will be cause for revocatlan of permle death Applicant <br /> person osd mage t to I prop6ny wcuBr nity <br /> g at Ino site <br /> harmless against any and all losses, costs, or damages resulting from Injury to parsons, p <br /> of. or as a result of work to be performed under this permit. Aeerdflcate of Insurance shall be submitted to the City Rlek 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 REOUIHED 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 PROVE S PRIOR PERMITTEE BEA NG OFAORK.)TCT ASSIGNED CITY PROJECT ENGINEER AT (209) 937-6411 FOR <br /> SPECIFIC INSTRUCTIONS <br /> READ GENERAL PROVISIONS ON REVERSE SIDE OF THIS PERMIT SEFOAE SIGNING. <br /> Signed; Phone: <br /> 1st•Pennitlee (white) Rnd•Infpeclion (PInIQ 3rd.Flla (yellow) 4Ih•Flneaee (walls) <br /> I 1� <br />