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OCT 26 '01 11:03 FR LF*VINE FRICKE 510 652 2703 TO 1683433 P.02i07 <br /> Oct 25 01 10: 20a <br /> ,*VINE <br /> StocktonPIJ-Permit (Z 37-8901 p. 2 <br /> no21'062 <br /> 00 2$062 <br /> Do 2$0lP3 <br /> 0 6 ,?s <br /> CITY OF STOCKTON <br /> M9PUBLIC WORKS DEPARTMENT <br /> 66 65� <br /> M05 APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF•WAY <br /> ),Iu�.nJ Ca.�rer. CNr,nawv..b.rrw4 let+-aeMirw 'fwsr <br /> pp��plitant'sNameye L11urNE r'uccL. Date 0� 1'01 APPROVED:BY THE PUBLIC WORKS DIRECTOR <br /> (Ownedcontraclor) <br /> .t.(i r^ Subject to the General Provisions and Spetiat Condtions,and all <br /> Address 11 r0 P rrcw ST. I z. f.- Phone Ste 651' 45ae work must conlis"to the pMecfs approved Somt Water Pollinian <br /> Clry 6Mfgry1'L6 State CA. Tip R EL46 Preveman Pier(or the city of stocldo,stone water Pollutirnr <br /> Prevention Maintenance Staff Guide,whichever is applicable. <br /> I�cation of Proposed Work,etc. (/jyjlhyC LecA'DdIK eV YN4LEwauO <br /> AVENM 011i suer 11 1-- r aF 96.4-'v &vr Ati <br /> Owner)Contractor AddressSAatE _._ y..� i Data <br /> Estimating Starting Date S•r'kr15Ew. Zen) Completion Date ""c i rmk Expkatlon Date_ - /"t T <br /> I (or We) hereby apply for an Encroachment Permit to carry out the following work: <br /> ZArr rear of 'fit[��7�A/ (Q) dA'Ois+e�wA7EA- A±, a 4I rl im-1 7//E Ago A4 L 97 <br /> off �.NriC.Fa..arrn .A <br /> The abo named edegmhr AuebY mouear m mu an to- <br /> SEF /G[h? PERMITFEE......._.._...............$ 2ZS <br /> , Ke i jl _�� J In �r I'� Additional Footage Fee............S <br /> Yl Trench Fee.. $ <br /> Sewer Tap Deposit.................... $ <br /> TOTAL DEPOSIT.........$ 'r <br /> Building Permit No. <br /> Improvement Plan No. <br /> ��Supplemental Conditions: <br /> -1 - <br /> hYfirVll� <br /> Z� tr c�4V S L'-'1A IL dautbed <br /> 6new d�roan o.rarer id bvwna wdnaW � (�f I itx/ V l a�+i / <br /> IMPORTANT'. Applicant hereby agrees in comply with all provisions of this permit,as well as all applicable City ordinances,resobAcr e, <br /> Standards and SPadfioetlmts currently in effect,and to Pay to-he Cfly Its actual cost for removal and proper replacement of any item which does <br /> not most the above requirements.Failure to comply will be cause for revocation of permit Applicant agrees to Indemnify and hold the City <br /> hermless against any and all[owes,costs,or damages rasulang from Injury to persons,death of person or damage to property occurring at the site <br /> of,or as a result of,work to be performed under this permit.A carldicate of Insurance shell be submitted to the City Risk Manager poor to Issuance <br /> of this pemUt <br /> PERMITTEE SHALL CALL(209)997.8966 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$HALL CALL FORA NEW CONTROL NUMBER.(FOR CAPITAL IMPROVEMENT PROJES O <br /> CT <br /> SUBDIVISION IMPROVEMENTS,PERMITTEE WALL CONTACT THE ASSIGNED CITY PROJECT ENGINEER AT(209)997.8411 FCT R <br /> SPECIFIC INSTRUCTIONS PRIOR TO THE BEGINNING OF ANY WORK.) OR <br /> READ GENERAL PROVISIONS ON REVERSE Slbe OF THIS PERMIT BEFORE SIGNING. <br /> Signed: <br /> OCT 25 '01 10!43 209 937 8901 PRGE.02 <br />