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- , - CITY OF ST_OCKTON <br /> r � ` 09PARTMENT OF PUBLIC WORKS <br /> - •._' - APPlICAT' ;: FOR ENCROACHMENT_ON PUBLIC RTGNY�F-WAY <br /> ,,. <br /> q�rt Name UNOCAL, �Co `tion 4 6 $ J 7905 <br /> c CA"trawforl'-- — - _ date <br /> Addtet •a -A'yn�ea <br /> � <br /> lovallpn of i'�4posea 7Vorlcret k CA at.s icte•n �Pa if z i.__6v�-n�rc APPROVED. DIRECTOR OF PUBLIC WORKS <br /> between Walnut and Alder Streets <br /> Lf+'t,er• arra{ Agdrt.,y S r am c �1 U 9 � • <br /> nn Road a�-.,� -�ycer s <br /> acr;3merito, 9582$ Y Date <br /> Eivimatod Start Dote / i <br /> Completion Dole I! p� � Permit Exp;rotlon C+nte <br /> 1 {or We) h"eby apply for on encroachment permit to tarry out the folio Dri_I two $-inch-diaTneter <br /> boreholes ?.p appruxiRt&tal5_ fe t o I work; <br /> :Ourid--Water moniC ti �$_ L_7_inrt]-inn,rw�l;a�,.^S�� " <br /> a n wells i <br /> r eti ?it's hnx Set flush with th sa• r <br /> 'f <br /> The above named appli,nnt htreby requests perm,st,ion <br /> PERMIT PEE ..,. . ....., ...... S 50 QO a <br /> Addit{onol Phot ; <br /> ape Fee �p <br /> . � s <br /> ` Sewer Tog) Deposit, <br /> TOTAL OEPOSIT .... ..... ... ........ Q a <br /> J <br /> SEE ATTACHED SITE PLAN <br /> Building 9tmit No. <br /> ' Improvement Plan No. <br /> i SUP08mental Conditions: <br /> I <br /> Show sketch ah4ve or refRr ro drewmq submirred <br /> 1 <br /> APORTANT: Applicant hereby agrees to comply with all provisions of this permit os well as all applicable +t <br /> ,solutions, standards and specifications currently in effect, a.-,d topayt pp C Y ordinances, .F <br /> 'ent of any item which does not meet above requirements. Failu e a omtty its actual cost for removal and proper replace- <br /> 'nt rsgrees to indemnify and hold the City hormfe;ss against any and all <br /> losses, +ll cabs couse for revocation Of permit- Appli. <br /> *TSOris, death of person or domaye to propertyoccurring Or damages restdlting from iniury to <br /> got the site of as o result of work to be performed <br /> trrnit. Certificate of insurance wilf be presented by ttpp;Kant span request- <br /> under thisst- , <br /> %ad General provisions on reverse side of this permit before signing, *Note requirement of notificatlons and Inspections. " t <br /> Pe"mIt Engineer/Inspector <br /> 844.8492 <br /> 944.8386 <br /> err >ss, Appllephone (916-452-2901 t' <br /> 2rca 50Syste s ��`� �' ' <br /> r <br /> 'erm,rr,» 1+t�-f d"..i�nvrxe ith -Utility/Sr reel <br />