Laserfiche WebLink
�n--? / " C) 4 <br /> CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKSYEC E I V E D <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF- <br /> or FEB 16 2001 <br /> Apppwnlicant's Name flats <br />' <br /> (S <br /> .'/ <br /> ENVIRONMENTAL AUDIT <br /> Address 1000-A 2ftgga Way Pha014 632-$521 <br /> APPROVED PUBLIC WORKS DIRECTOR <br />' city Placan I-i a State fAZip 92870 <br /> Location of Proposed Work etc 5606 PaQ.1ficAVP_T111e <br /> Stockton, CA `{ <br />' By Owner/Contractor Address <br /> Dais <br /> Estimating Starting Date Completion bate�4���101 Permit ExptraUon Date <br /> I (or We) hereby apply for an enroachment permit to carry out the following work Install 2 ground water <br /> monitorin wells in the sidewalk. <br /> The above named applicant hereby requests permission to PERMIT FEE $ 12800 <br />' See Above Additional Footage Fee $ <br /> Sewer Tap Deposit <br /> TOTAL DEPOSIT $ 12800 <br /> Building Permit Na <br /> Improvement Plan No <br /> 1 Supplemental Conditions <br /> Dee P&W <br /> Figure Attached <br /> Show sketch above or refer to drawing submitted <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 the <br /> City harmless against any ana ait losses, costs, or damages resul+ing from Injury to persons death of person or damage to property <br /> occunng 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 City <br /> Risk Manager prior to beginning construction <br /> ePERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1-800-642-2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES <br /> .*ERMITTEE SHALL CALL(209) 937-8411 24 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 signin - Note requirement of notifications and Inspections <br />' Phone <br /> 63 <br /> Signed <br /> 1s1 Permittee <br /> 2nd File 3rd Finance 4th UtililylSireei <br />