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JAN 28 '99 09: 12 FR LFR LEVINE FRICKE , - 5;.0N6S2 4906 TO 12094683433 P.02/11 <br /> �JHN-14-1"9 1525 �IC WORKS PERMIT CENTR *9 937 eg01 P.02 <br /> ♦w CITY OF STOCKTON <br /> 64899 <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-or_WAyp�BZ�Y <br /> r ,/ <br /> (�OpwpnlVe,nr[�CfepJmNraxmb.p.p�i/'f/�' •!.r—.uy.zey"IdA-a„ _ -PD..0.110IO1.0 nSOU-LAfSOz,S{C_ef.2I._e� <br /> �.ti.10 � Skims•_ a <br /> Mores 9oP _OE'!'v �J <br /> Cis��s <br /> LOCO"01 PMPQWd Work, tc �hUPY <br /> ee <br /> / <br /> APPROVED-- PUBLIC WORKS DIRECTOR �IOQ <br /> OwnprCOntaaOr rod,.:: _ _----_ ar. .f• rnd..�.J_ .j;�_�} till) . <br /> oen.� r <br /> Esfnwed SIM1nq Dae C r Plwlon oat. //10/p vennd Etpirati0n Dete 1^S 1 <br /> I (or We) hereby apply JG1 ,,c,,oao1hmentennpermit 10 Carry Out the tollgwing work: .. . _ <br /> C L N P0 yY <br /> A-7 _Sa.tlr4 S s - <br /> ju 3y--W.t�' °a- c�SLvr»�}�yr� CIO <br /> �g3' O.r nw_II <br /> 2ee.4:(rte a.e�--• -' !_� , x 6/do .Se birJ. .P /?ocS��C4- 33� <br /> Tnp fnl..warye nuu�san nrrcq meWOe f»mys4n to __ -_ <br /> PERMIT FEE <br /> AndRional F001ege Ppl! _-__ _. - <br /> Se-C, Teo DPP"'r <br /> 40C. LQ 3 TOTAL DEPOSIT.. <br /> 5urlding Permit No. <br /> (/ Improvement Plan No. �•_ <br /> Supplemental Conditions: <br /> tk)eI-L 613-14iu 'U-- nL.rLCcn <br /> W t�\r.1 `1aF S='t�rczklw'�., Lfa>,�>= • <br /> Snnw prPCn ebey w 4k•b O,winq wbm•nee <br /> IMPORTANT.Applicant hereby agree.•.to comply with all provision$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 lot 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 agwnsl any and all losses,costs,or damages resulting from injury to persons,death 01 person or damage to property <br /> occuring at the she of or as a result pf work to be pedOr4led under this permit A certificate of in9uranee shall be submined 10 the <br /> City Risk Manager prior to beginning construction. <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1.900.842.2444) TWO WORKING GAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> 'PERMITTEE SHALL CALL 12(19)937-6.1 2A HOURS PRIOR TO START or WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> 'ECTION. <br /> Read General Prov1510ns on reverse side of this permit before signing — Note requirement of notifications andinsspections. <br /> 13) r _ <br /> :rte r..,nrr'. ,iA LI,I,ITI{Irnnl <br />