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FROM : GETTER–RYAN INC. • PHONE NO. : 916 631 1317 • Oct. 24 2000 11:14AM P2 <br /> 64848 <br /> CITY OF STOCKTON <br /> #OQWA PUBLIC <br /> DEPARTMENT OF PUBLIC WORKS <br /> A# ��i.��r f APPLICATION FOR ENCROACHMENT <br /> O�N PUBLIC RIGHT-OF-WAY <br /> SJe4 — ( n-_. Date �� Z�_✓1/. <br /> H.pliWnt's Name ...�,--_-�� <br /> rlef/ `x810 G - -.... /' q►b"681_1J:—V <br /> Address tyy Pt J�+.i <br /> phone <br /> 'l <br /> APPROVED: <br /> PUBLIC WORKS DIRECTOR <br /> Location oI Proposed Work,etc. <br /> OwnerlConVaIXor Address �..,�\. <br /> :4- .... y <br /> Completion Date I I. IO fmi(Expiration Dale <br /> Estimated Sterling Date <br /> I <br /> I (or We) hyr(y,e�.by apply for an ncroa hrent it to arty ur t the follo ng work, k <br /> Tit,abwc namee wacant hereby requests permission th PERMIT.FEE...................... "- <br /> 1 1 <br /> Additional F00139e fee .... <br /> Sewer Tap Deposit ............. <br /> . TOTAL DEPOSIT........ <br /> Building Permit No. <br /> g C Improvement Plan No. ... - <br /> S'upplemental rOnditio ,^ <br /> � t �t f (,tk6 <br /> 0 fcw ILL <br /> Show sketch above or refer W 4rawin9 submitlol <br /> iMRORTANT:Applicant hereby agrees to comply with ali 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 injuryto persons,death of person or damage to property <br /> ooeuring 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. <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-800.X42.2444) 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 per b fore r r — Note requirement of notifications and inspections. <br /> luI-Pnrmionr. :no-Filo 3k..-Finance aln-UOutYr$Irpe1 ' <br />