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OCT 26 '01 11:03 FR LE LEVINE FRICKE 510 652 2703 T0�94683433 P.02i07 <br /> Oct 25 01 10: 20a y of SLooktonPW-Permit [ 7937-8901 P. 2 <br /> no28o59 <br /> 00 25-040 /l <br /> ooz�o6Y ��ni-3l <br /> S CITY OF STOCKTON <br /> PUBLIC WORKS DEPARTMENT 66 65� <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> (jmu .1 Ca.W6r. CNv,ns+•-6wrA4 leb"FaM -rv.-sr <br /> gqppplioanfEMM <br /> LQWN[- Fucr- Data Zjj. a <br /> (OvmeNcAPPROVED.BY THE PUBLIC WORKS DIRECTOR <br /> Address_ aac. ST. l7..Tp F.. Phone 516 6sb' 45ee SubJect to tha General Provisions and special Conditions,and all <br /> work must cotdorm to the pro(ect's approved Storm Water Pohuson <br /> Clry State CA. 4p I'M Prevcnpon Plan or the City of Sb�ckton Storm Water Pollution <br /> LaOatbn oWar,etc. C urcA Prevention Maintenance Staff Guide,vfthaver is applicable. <br /> 4t.E+�wO <br /> u , t- o w, <br /> Owner/Codress SAh+.E Y-� I Data�Estimatingte K56w- 2ao) Completion Date a,r c i tmit Ettpbatlon Date <br /> 1(01 WO) hereby apply for an Encroachment Permit to carry out the following work: <br /> rj <br /> of 6 d/ms+OwWs s.vE wrrN.'N 7#4i pn4,eVA4 c4rv&7 <br /> om <br /> Tha aba.a nyrpe 8=ft a Nnbr mauane pbmiWvn le <br /> SEE PERMITFEE............................5 2tS <br /> Cr I'� Adtlifional Footage Fee_..........$ <br /> Trench Fee............................... S <br /> Sewer Tap Deposit....................$ <br /> TOTAL DEPOSIT.........$ <br /> Building Permit No. <br /> Improvement Plan No. <br /> .� Supplemental Conditions: <br /> Hn '1 �-¢ h%AL. C6su' ^3rd <br /> y� b�C�V'iL�frlG ��Lc�„-�ll IL C�Ol:;3irc� <br /> Gnaw ely{q,aLaw 01 W01 w dnwde wbmbrp r U l <br /> IMPORTANT: Applicant hereby agrees tc romply with WI prowaians of this permit,es well a6 flll applicable Clty oralhances,resolutions, <br /> 518ndard8 and Spetlficatlong currenty In affect,and to pay toifta Clty Ita actual cost to <br /> removal and proper replacement of any item which does <br /> not meat tlta tlbova requiremanb.Fall" b coMP tw it because <br /> to <br /> revocation of permit Appticant agrees to Indemnify and hold the Ctty <br /> hermleta against any and all bases,costs,ar damages reswtlng Iron Injury to persons,tleflN of person or damage to property occurring at Me she <br /> Of,ar as a resuh af,Work W he pertormed under this permit.A caltificata of Insurance shW ba submitted to the Ciry pick Manager prior to issuance <br /> or that Pamdt <br /> PERMITTEE SHALL CALL(209)937-8366 FORACONTROL NUMBER NO LESS THAN 24 HOURS,BUT NOT IN EXCESS OF 72 HOURS, <br /> PRIOR TO THE START OF WORK,AND PRIOR TO ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE SIDE OF THIS <br /> PERMIT IF WORK DOES NOT BEGIN WITHIN 72 HOURS OF THE ISSUANCE OF A CONTROL NUMBER,THE CONTROL NUMBER WILL <br /> BECOME INVALID AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER.(FOR CAPITAL IMPROVEMENT PROJECTS OR <br /> SUBDIVISION IMPROVEMENTS,PERMITTEE SHALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT(209)937.8411 FOR <br /> SPECIFIC INSTRUCTIONS PRIOR TO THE BEGINNING OFANY WORK.) <br /> READ GENERAL PROVISIONS ON REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. <br /> OCT 25 '01 10!43 209 937 8901 PAGE.02 <br />