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09/ 04 / 2002 14 :09 20946711 AGE STOCKTON N PAGE 02 <br /> Sep 04 02 01� 3910 L 4 Of StocktorlPW - Permit ( 2L . S37 - 9901 10p3310 , 1 <br /> 5R003©o4�F <br /> CITY OFSTOCKTONDEPART /�r' 6+ p� <br /> PUBLIC WORKS DEPARTMENT p V� �y4 <br /> IM15 AnPPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT OF-WAY <br /> I A pUcanes Namelld ItGnrad �9ec nvigtnMrx ate . 6"1 - 03- 02 APPROVED: BY THE PUBLIC WORKS DIRECTOR <br /> contractor)))""TTT p <br /> �-17' C1A.J n O �� \p D1) q (41 ,- oQ 6 Subfd to the Carteret Provielons and Special Conditions, and all <br /> Address l t\ work must conform to the project's appneved Storm Water Pollution <br />! Prevention Plan or the CI of 5tockton Storm water Pollution <br /> city ort1G� vyt state CA zip � Z fS N <br /> Prevention Maintenance Stall Duda, whichever Is applicable, <br /> L�ocjatlon of Proposed Work, etc/...t PA t j Pt L CA r W ctS� �� Z/ bid Z <br /> IM5 PaC � �: G /YVGr1U � _ _ ! <br /> Owner/ Contractor Address ems_ B _Data /� —dammer id <br /> Estimating Starting Date „ ,'7v •' " •- Comp711 lop <br /> letion Date a�� admit Expiration Data :t /.-o C� <br /> I (or We) hereby apply for an Encroachment Permit to carry out th follow) g work: T�nS4411 W Ma % rrn . <br /> Ld OldIA e an � a on SSM <br /> me aCove nerved ebpllCenr hereby requeBra parmiealon n - <br /> PERMIT FEE .... ... . ... ............. .... $ l S <br /> ReF�t a GG�e �t SIYQ � 1ar� Additional Footage Fee ,,.. .... .... $ <br /> Trench Fee .... . .... .... .................. $ <br /> Bawer Tap Oepesit...... ......... . .... $ <br /> TOTAL DEPOSIT ...,... . . $ ' on <br /> I <br /> 07r, v O , Building Permit No. <br /> Improvement Plan No, <br /> Supplemental Conditions: <br /> Show skohn alfa ic <br /> tl <br /> nlerto w ng aubm lNO Ck <t`—^MJW 1F— C05 s L <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of his permit, as well as all applicable City ordinances, resolutions, <br /> Standards and Specihcatons currently in effect, and to pay to the City Its actual cost for removal and proper replacement of any Item which does <br /> not most the above requirements, Failure to comply will he cause for revocation of permit. Applicant agrees to indemnify and hold the City <br /> ISI 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, of as a result of, work to be performed under this permit. A certificate of Insurance shall be submitted to the City Risk Manager prior to Issuance <br /> of this permit. <br /> PERMITTEE SHALL CALL (209) 937-8386 FOR ACONTROL NUMBER NO LESS THAN 24 HOURS, BUY 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) 9374411 FOR <br /> SPECIFIC INSTRUCTIONS PRIOR YO YH6 BEGINNING OF ANY WORK.) <br /> READ GENERAL PROVISIONS ON REVERSE SIDE OP 1 ER /yBEFORE SIGNING- <br /> Signed: Phone; <br /> Ist-Perinittee (while) d-lnspeclion (drink) 3rd-File (yellow) 4M-Flnanc0 (wNto) <br />