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© CITY OF STOCKTON 65217 <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Applicant's `'rkd:ro+w..l+.� ZeS al..-1.�...L-bate IIz4l9a <br /> (Ownerl ntraco <br /> Address -`\ :�,4"A `l�`�.,z S"'{e' �^ Phone /4t1"17yL-�l+t' <br /> APPROVED: PUBLIC WORKS DIRECTOR <br /> Location of Proposed Work,etc. <br /> Owner/Contractor Address j..-os w B ' Dat <br /> Estimated Starting Date 11-2'Le Completion Date 1 I?1199 Permit Expiration Date <br /> I (or We) hereby apply for an encroachment permit to carry out the following work: IcsZ�k ZT tum <br /> 1 3Qs Q_ t tilt%:LL - - �ClF3ltl l�bY1� IIP <br /> c�= PnC-L'�- C IS kZA� CIT= <br /> @ yt7i 1+a \t <br /> 2c,61 Kit Lx2f <br /> la1 "S ll l� <br /> The above named applicant hereby requests permission to s <br /> PERMIT FEE..................... $ <br /> 'fir{ t�f - --�7 c c� Additional Footage Fee............. <br /> Sewer Tap Deposit ................ <br /> TOTAL DEPOSIT......... <br /> $ ' <br /> t Building Permit No. <br /> Improvement Plan No. <br /> ��C1 F4�LlIr j (` Supplemental Conditions: <br /> ou n_cc �:ev�C ctr�i�E_ <br /> Show sketch above or refer to drawing submitted ``t� C`o 1(`� ����., p�/'�" k` �•'�"� ,�/ � <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions 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 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 City 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 to the <br /> City Risk Manager prior to beginning construction. W4?— <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1.800-8+t2-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL(209)937-841124 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 — Nate requirement of notifications and inspections. <br /> Signed. � &L1___-_ ___ Phone-_-IZ -�" 1��____ . <br /> Isl—Permittee 2nd—File 1', 3rd—Finance 4;n—ublityl Street <br />