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0 06 / 29 ( 2001 07 : 52 2094671?s; AGE STOCKTON PAGE 04 <br /> CITY OF STOCKTON <br /> PUBLIC WORKS DEPARTMENT � �� 3 <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY R <br /> Applicant's Name ttnCF.dL � l!o C.nv(rdnrvt N Date 05--X- -C31 APPROVED; BY THE PUBLI WIO�RKSDIRECTOR <br /> (9wneNCantraotor <br /> pp ` , -,/ y /��� � � $ubjectto the General Provisions and Special Conditions, and all <br /> Address 93 � SiAai gZoc Phone t'r.0 / �Ir.4N� work must conform to the projects approved Storm Water Pollution <br /> City A. S +6e'k+0 l State CA Zip 7,T;t k5E- Prevention Plan or the City of Stockton Storm Water Pollution <br /> prevention Maintenance Staff Guide, whiohever is applicable. <br /> Location of Proposed Work, etc. y �J� PraC , � � is Qr 0!` <br /> C.c ' Gf� C wr W ` sk 7 ' O <br /> Owner/ eee,traeteraddress\\, '"J%5� P&CFJ '4 z AU ., By D1p/to 21 <br /> Estimating Starting Date cli \ l 00 Completion Date 30y C5 , A[;o k /I Permit Expiration Date Vol <br /> 7/ <br /> 1 (or We) hereby apply for an Encroachment Permit to carry out the following work: AcOvaACe_ oaq 50 ; r, ',t . <br /> (t,1-i I � a CPT R ; +o A ceK fr U �4 ILLA AAI IC Ect"h & Lvc ,' Ave , <br /> 4.t�t- i 5 Lu . � +off. IDc,W.'�+�Q near ' a� rrer�-F �'1 t.J •� (1r� <br /> . � L*• G r4'pf� V\ Ce%EjE `rt tk to1'vt UrA �Ai� W0/'L W . JI 7R C1 a' <br /> S_ ho �rs . S, e. walK S _c. + i 'nn w 11 be- m9kAce & OF + er rlan ,io , •h� wee/ � <br /> no above named appllc nr hereby requests pormismm to - <br /> ��++Q (� rr PERMIT FEE ......................--.- $16SJ 1M A^ tz <br /> rr <br /> 1 � '•�r� r— Additional Footage tea ......------ $ <br /> Trench Fee ..........................."A' $ <br /> Sewer Tap Deposit.................... $ <br /> TOTAL DEPOSIT ....A.... $ <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> 1yb 1ttw� Mh:44 13AGAVE CLOW <br /> CM Cu.A[4 \MW� ZMASXA1fs "Cti4Ii OF <br /> VAGAi <br /> 2 E��� 10N Cti ee !��L CF=sCC¢cX. Swhx.L <br /> Show aka'a abo" or refer to drmamv oubmmed CAtA>�t2�� <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 affect, and to pay to the City its actual Cost for removal and proper replacement of any Item which does <br /> not meet the above requirements. Failure to comply will be cause for revocation of permit. Applicant agrees to Indemnify and hold the City <br /> harmless against any and all losses, costs, or damages resulting 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 penult- A certificate of Insurance shall be submitted to the City Risk Manager prior to Issuance <br /> of this permit. <br /> PERMITTEE SHALL CALL (209) 937-6366 FORA 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 OFA CONTROL NUMBER, THE CONTROL NUMBER WILL <br /> BECOME INVALID AND THE PERMITTEE SHALL CALL FORA 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 INSTRUGTIUNS PRIOR TO THE BEGINNING OF ANY WORK.) <br /> READ GENERAL PROVISIONS ON REVERSE SIDEOF ERMIT BEFORE SIGNING. �1 /` •-� <br /> Signed'A Phoma: 7 ! "z[PC7Ph <br /> isAPenmhee (while) 2n4nspection (pink) 3rd-file (yellow) ash-Mri (while) <br />