Laserfiche WebLink
OCT 26 101 11 03 FR LlEUINE FIR ICKE 510 652 2703 TO 1683433 P.02i07 <br /> t <br /> Oct 25 01 10: 20a of 5ocktWrmit <br /> onP -Pe12 37-BSO1 p•2 <br /> - �Q. nv28o59�rr�9/d� <br /> CITY OF STOCKTON <br /> 00 28062 <br /> ov 2Frol�3 <br /> oo2�obydl3f� <br /> SAPPLICATION <br /> PUBLIC WORKS DEPARTMENT FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Liur.,�a Ca.vre. eN�,no•wwrw4Re-a�.nwTwsr <br /> AqpppltwnfS Narl Lil Fucr-a- oat. zh.*/aI APPROVED: BY THE PUBLIC WORKS DIRECTOR <br /> (OwnedConlracl0r) <br /> Address IIID PorJau.. ST. 11.Tp & Pnone Sla 65t' 4 a� Subject to the General Provision and Special Condtiom and all <br /> work mustconform to the projeLfs approved S%c n Water Po9ueon <br /> State CA- zip 17%ai Prevention Plan ortheaty of Stockton Storm Water Pollution <br /> wr, Prevention Maintenance Staff Guide,whichever is applicable. <br /> Laxation o1 Proposed Work,etc. I/Allri G L#&420rK o&2 5P4LE WO <br /> AV✓ENur- up GWr a t- f o£ 964MW url., 40- <br /> Ownerl Contractor Address SAMEy✓ I Date �G•,� u <br /> r <br /> Estimating Starting Date SreTtnsEw- 2s 1 Completion Date 'y"14' rmk E%pvatlon Date_ ',�—C'� L <br /> I (or We) hereby apply for an Encroachment Permit to carry out the following work: <br /> :6,rr, rev OF Y cw C!�� d tou+c7w sYErt ayf�e c 4I F7YJ�✓ 7/jE PtlWkrAl, L4N� <br /> The above-y deaeamryhembYMamlry,miaslonle <br /> - <br /> PERMIT FEE............................ <br /> Additional Footage Fee_..........$ <br /> Trench Fm............................... $ <br /> Sewer Tap Deposit..............•,,,,.$ <br /> TOTAL DEPOSIT.........$ <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> �V -"�1 }}••�.1 la�� cls-�.tv� a•� <br /> •�JMt'�V�L. <br /> �� r+CWt1^ C111� 5 �t.Cnil v— <br /> [jLl�fitYJ 2[� <br /> Gnaw rbW�Nor.or rviae re ervrnno aemdlad <br /> IMPORTANT Applicant hereby agrees to comply with all provisions of this permit,as well es all applicable City ordinances,resolutions. <br /> Standards and Specifications currently In affect,and to pay to-Me Clry In actual Cost for removal and proper repkUvrnent of any Item which does <br /> not most the above requiremoms.FBliure to Comply will be cause for revocation of permit Applicant agrees to Indomnhyy and hold fire City <br /> harmless agelnat any and all losses,costs,or damal resorting from Injury 10 persons,death of person or damage to property occurring at the she <br /> of,or as a resuh of,work to be performed under this pamlt A certificate of insurance shall be submitted to the City Risk Manager prior 10 Issuance <br /> of this pemUt. <br /> PERMITTEE SHALL CALL(209)937.8366 FOR A CONTROL 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 OF ANY WORK.) <br /> READ GENERAL PROVISIONS ON REVERSE SIDE OF TM PERMIT BEFORE SIGNING. <br /> Signed: <br /> OCT 25 101 1043 209 937 13901 PAGE.02 <br />