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' FROM GETTLER-RYAN INC. PHONE N0. : 916 631 1317 1 1 May. 17 2001 03:07PM P2 <br /> CITY OF STOCKTON . <br /> PUBLIC WORKS DEPARTMENT <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> ,i rte^ <br /> Date APPROVED.BY THE PUBLIC WORKS DIRECTOR <br /> Applicants Name C to the Genesi Provisions and Special(`grtdltiorls,and a]i <br /> (ownerlContrador �,, Subject <br /> ( � 17U Pnonett� 6 I r I work must conform to the profs approved Storm Water Pollution <br /> Address,31 O �(� �-� ` ^x'70 Prevention Plan or the City of Stockton Sloan Water Pollution <br /> �Y t� State�� ZipPrevention Maintenance Staff Guide,whichever is applicable. <br /> Location of Proposed Work,etc. <br /> � � � Or� µxta.l � <br /> Date <br /> owner/Conte or Address d� <br /> 40, <br /> QS�7 By lI <br /> Z I Compkstion trate 2 rmit Expiration Date <br /> Estimating Starting Data_ � �- <br /> t for an Encroachment Permit to Carry out the following work: <br /> I (or We)hereby appy t ' <br /> rv►nr.� r 1.u, tri �6 GLT � - � csa" a t,-% <br /> i <br /> I <br /> 1Tp gk Awa named applicant Ingrob requeele permission to <br /> r [� PERMIT FEE............................$ .--.- <br /> i <br /> � T � <br /> Additional Footage Fee............ 5 , <br /> Trench Fee............................ $ <br /> '(1 I <br /> ISO Sewer lap Deposit--.............$ <br /> I <br /> I TOTAL DEPOSIT.........$ r <br /> Building Permit No. <br /> C Improvement Plan No. <br /> Su plemental Conditions: <br /> �iN Con, G� <br /> w � � � ftl <br /> -L Vj <br /> show rkocbh above er<eter to drawing submitted K1 w <br /> IMPORTANT Applicant hereby agroes to comply with all provisions of this permit,as well as all applicable City ordinances,rosoluttons, <br /> Standards and Specifications currently in effect,and to pay to the City Its actual coat for removal and proper replacament of any item which does <br /> not moat the above requirements.Failure to comply will be cause for revocation'of permit.Applicant agrees to indenmify 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 permit,A certificate of insurance"I be submitted to the City Risk Manager prior to issuance <br /> of this permit / <br /> PERMITTEE SHALL CALL(209)9376 66 FOR A CONTROL NUMBER NO LESS THAN 24 HOURS,BUT NOT IN EXCESS OF 7`2 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 PRO.IECT ENGINEER AT(209)937-8411 FOR <br /> SPECIFIC INSTRUCTIONS PRIOR TO THE BEGINNING OFANY WORK.) <br /> READ GENERA!^PROVISIONS ON RF-VERSE SIDE OF 1S EFt RE SIGNING. <br /> signed; — Phone, <br /> 1 St-Permittee(white) 2hd•Insp6ction(pink) 3rq•Flte(yellow) 41h-Finance(while) <br />