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feaCITY OF STOCKTON 64008 <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Applicant's Name Kennedy/Jenks ConsultantsDate 8/23/96 <br /> (Owner/ okacjgr) <br /> Address SS JJecond St. S.F. CA 94107 Phone(415) 243-2150 <br /> Location of Proposed Work, etc. In the vicinity of the intersection APPROVED: PUBLIC WORKS DIRECTOR <br /> of East Market and S. Stanislaus Street (see attached <br /> Owner/Contractor Address Kennedy/Jenks By Date fi • 3i - 5r <br /> Estimated Starting Date mid to late Sept. Completion Date mid to late Sep Permit Expiration Date QCT :51 , 1991v <br /> three <br /> I (or We) hereby apply for an encroachment permit to carry out the following work : To drill €ebir- soil borings on East <br /> Market Street and one sieF 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 II environmental <br /> investigation. The soil borings will be drilled, sampled, grouted, and parse patched in one <br /> day. No soil borings will be left open overnight. The location of the proposed four soil <br /> borings is presented on the attached Figure 1 . <br /> The above named applicant hereby requests permission to- PERMIT FEE. ... . ..... .......... $ 00 <br /> Additional Footage Fee .. ..... _. <br /> PLEASE SEE ATTACHED FIGURE 1 Sewer Tap Deposit <br /> TOTAL DEPOSIT $ 00 <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> t�a2�Hc� -Tv\lr= C,pLa¢.se oV— <br /> Show sketch above or refer 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 <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. 644 <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1-8002444) 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 /> Read General Provisions on reverse side of this permit before signing — Note requirement of notifications and inspections. <br /> Signed: li..`_'.t1�1'T'- r ` V� —_..------. Phone y�r-7-'1 3 <br /> 1st—Permatee 2nd—File 3rd—F,na ce J`�- 41n—Uhhtylstreet <br />