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04/29/96 08:20 M-a'illill,372 5220 1T CORP MARTINEZ Q001/001 <br /> CITY OF STOCKTON <br /> DEPARTMENT OF PUBLIC WORKS <br /> APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT.MWAY <br /> N! 62303 <br /> Applicant's *46._L7 <br /> (Owner/Control terAllf <br /> 6 Phorn '4/0 <br /> tiv <br /> APPROVED: DIRECTOR OF PUBLIC WORKS <br /> Location of Proposed Work,etc. <br /> CC tractor Addre" f iA/ 5l4t+1 U By <br /> Estimated S>aNiny pati 1 ComPlarion fbfe� 7 Per it Expiration Date- <br /> -CA <br /> I (or Wel hereby apply for an encroachment permit to carry out the following work: r'1Ll -./DF'r� '��- Du T <br /> t 16t,. %,J IV A t— 'M e M%9,00TOAINC, %,Jg"S r t v 1� <br /> r t t woC K. 4.•It#w.t <br /> The above named applicant hereby requests permission to- PERMIT FEE_......................................... 3 <br /> [� �G+ M 1 Sewer Tap Deposit .................................. <br /> RIV C f`� �H b / TOTAL DEPOSIT ...................... $ ,�.05 so <br /> Building Permit No, — - <br /> improvel,knI Plan No. <br /> Supplemental Gonditions: <br /> ( SKyEWRL1G afL Paw�i3 A�j° �► - <br /> t tz"lcuAt, .t, <br /> CEJ "4- Skak� .� � -c�'►c�ad <br /> veep. "e tcL. L..ANE 0WJA LN <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, <br /> resolutions, standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replace- <br /> ment of any item which does not meet above requirements. Failure to comply will be cause for revocation of permit. Appli- <br /> cant agrees to indemnify and hold the City harmless against any and all losses, costs, or damages resulting from injury to <br /> persons, death of person or damage to property occurring at the site of or as a result of work to be performed under this <br /> permit, Certificate of insurance will be presented by applicant upon request. <br /> Read General Provisions on reverse side of this permit before signing. ote requirement of notifications and inspections. <br /> Permit Engineer/Inspector 'e.-e <br /> 9444250signed: Phone <br /> 944-83M — <br /> PERMITEE SHALT,CALL 9374411 post-1r Fax Note 7671 Date -29.Q1, 1pages � <br /> 24"OURS PRIOR TO START OF TaA r Ry M E S tea'4 0.5 FSR IA 5 <br /> 1st—Permittee 2nd---file 3, QWORAsCDWfil0bWMBER co.tOept :�,Aev.w E co. f <br /> AND Phone a Mono* <br /> TO SCHEDULE INSPECTION <br /> _._._.. Fax 1t9L a9 4« ..�33 Fax <br />