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I <br /> 65251 <br /> a <br /> 0T"' Or STOCKTON <br /> DEPARTt�;c sT OF PUBLIC WORKS <br /> APPLICATION FOR ENCPO CHMENT ON PUBLIC RIGHT-OF-WAY <br /> /7 <br /> 0ppllcant s Name <br /> wnef!Contractor)), <br /> Address 7Y 12,'Q, , 'liyi✓P J4, v Phone -L/6) <br /> Location of Proposed Work etc /r �� u�r APPROVED PUBLIC WORKS DIRECTOR <br /> G' Z <br /> Owner/Contractor Address By A Date i 9 <br /> Estimated Starting Date Zf/z�J _Completion Date -2��9 y� Permit Expiration Date <br /> I (or We) hereby apply for an encroachment permit to carry out the following work <br /> F I I-L T <br /> The above named applicant hereby requests permission to PERMIT r-EE <br /> Lys S_ <br /> S/ F�!c� 4•S y��,��,,X <br /> C,/ Additional Footage Fee <br /> 1 '/ Sewer Tap Deposit <br /> TOTAL DEPOSIT <br /> Building Permit No <br /> Improvement Plan No <br /> Supplemental Conditions <br /> ,S00u,-n Th(E w�e� <br /> b2&et0l92r-- T)dE: etDtURt� Cq--- <br /> ANS{ TRA[i A U C..FO21C <br /> S 94LL � 2�-Tp.f GT�Q TD N I(71+T <br /> Show SketCh above or refer to drawing submitted <br /> IMPORTANT Applicant hereby agrees to comply with all provisions of tnis 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 <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 /> 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 <br /> City disk Manager prior to beginning construction Vfs- <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1-800-84~2-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES <br /> PERMITTEE SHALL CALL(209)937-8411 24 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION <br /> ead General Provisions on reverse side of this permit before si7�7 <br /> put7-1- --- <br /> of notifications and inspections <br /> Signed <br /> �� Phone <br /> ts[—Permittee 2rd—Fde —Flnance� ,n—Utility,Sire. <br />