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SEP-24-1998 14:51 PUBLIC WORKS PERMIT CENTS! 209 937 6901 F.01 <br /> `�i�'t`-�+•-rte �---+--•.,i�• :. . . � (• • <br /> CITY OF STOCKTON 64898 <br /> _ DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-0F-WAY <br /> Appplitanl'3 Nama fir{ Dalt z� <br /> (D..norl Conlmp0llr/0. OV toPl . 1 PFON <br /> AdOreSa / OQ,�.dr�e// it"�F� oi <br /> PnR- o APPRCMD: PUBUC WORKS DIRE=R <br /> laoon of Pmpoe Work.s10. ¢ ILW <br /> 9� ry Si�K ruC ,, p 6 /rV-aWlsl Dery Y�L3 <br /> Dwner/COn1raC10r Adtlroas <br /> Eslimad Starting Dasa FIAT7� plw <br /> ComOn Date -W P11.11EExpiyyrationn Date <br /> I (or We) hereb apply for an encroacent permit tocarry out t e f�iing'work: <br /> iZ.4L�- fd,2.44Q" <br /> Cl <br /> Tha ob"n.msd APPkanl har,OY'dVwab mfr dscn to PERMIT FEE ........ <br /> .. - —Addelonal Footage Fos --- -- <br /> -1 //)) $ewer Tap 0,0061 <br /> ... .. .... .. <br /> P it awa <br /> (� TOfAI DCPOSIT.. S � L <br /> Building Permit No. <br /> !�0 l' R o•n.. l l0 Improvement Plan No. <br /> Supplemental Conditions: <br /> NO TTLoJF,�L L&M41!6 SUIP.LL tic <br /> P,atO(zeo o grr ThyfF T>Av 114U <br /> /Z�l�ai` cO�t2`+rc 9F TN S WEQX <br /> l:!IIL---J:F / - <br /> IShow a410h iewa or rewr W drawl g submlu0 <br /> IMPORTANT.Applicant hereby agrees to comply with all provlslonsbf this permit as wallasall applicable City ordinances, resolutions, <br /> standards and specifications currently in effect,and to pay 10 City Ili: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 Oily 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 io she <br /> City Risk Manager prior to beginning construction. - , <br /> PERMITTEE SMALL CONTACT UNDERGROUND SERVICE ALERT(1.800-2444)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 /> Read General Provisions on reverse side of this permit before signing — Note requirement of notifications and inspections. <br /> tna—flea <br /> yrd.-FlnanPa an—Nnnyl Sven <br /> TOTAL P.01 <br />