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Q CITY OF STOCKTON <br /> 64008 <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Applicants Name Kennedy/Jenks ConsultantsDate 8123196 <br /> (Owerl <br /> Addresssofftreeond St. S.F. CA 94107 Phone 415 2143-2150 <br /> Address i!S <br /> Location of Proposed warts etc In the vicinity Of the intersection APPROVED PUBLIC WORKS DIRECTOR <br /> of East Market and S. Stanislaus Street {see attached <br /> OA <br /> Owner lContractor Addres5 Kennedy/Jenks By Date, 8 -52-- <br /> imstimated Starting Date mid to late Sept. Completion Date mid to Iate Sep Permit Expiration Date <br /> I (or We) hereby apply for an encroachment permit to carry out the following work To drill €est - soil borings on East <br /> Market Street and one stel•- soil boring-on S. Stanislaus Street. The purpose of the soil <br /> borings is to_collect soil and groundwater samples as part of an Phase 11 environmental _ <br /> investigation. The soil borings will be drilled sampled, grouted, and pare patched in one <br /> day. - No soil borings will be left omen overnight. The location of the proposed four soil <br /> brril3ns is ares-ented__on__the_attached_Figure_1 , <br /> The ao"named applicant hereby requests permission to PERMIT FEE $ c- <br /> ' Additional Footage Fee <br /> PLEASE SEE ATTACHED FIGURE 1 sewer Tap Deposit <br /> TOTAL DEPOSIT s 00 <br /> I <br /> Building Permit No <br /> Improvement Plan No <br /> Supplemental Conditions <br /> I <br /> I <br /> I <br /> � t�orr�� b�- ��t••-LE <br /> rShowc �cZ'E or- <br /> Show <br /> sketch above Or refer[o drawing submitted <br /> I <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 <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 Risk Manager prior to beginning construction C4Z <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-800.44Z-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES <br /> PERMITTEE SHALL CALL(209)937-841124 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 stgn,nnng— Noterequ,rrement of nottftcaboinctio <br /> ns. and spens <br /> �S neo Phone Cl r-Z`� j —7.S Z./1 <br /> 9 <br /> tst—Perm-gee 2nd—Fde j .1r o�. a�. �JL_TA4`� UtiinyiStreec <br /> rr `-�y"i <br />