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OTy OF STOCKTON <br /> DRARTMENT OF FlMK Wops <br /> Al"""T'ON FOR RASOACHWNT ON PMK ftw"T-ORWAy <br /> Fol <br /> N° 61790 <br /> L"Ni"of terra W"k APPROVED: pMCTOlt OF pUKK WOW <br /> oM�.�car,ueMe1.�.0 <br /> S <br /> softy OM Cen�plotien Fwrnil E■piratJen <br /> 1121 <br /> I Wel hereby aPPIY for an encroachment permit to carry out the following work <br /> 40, JKI <br /> The etMre 0- 'PACQer W04 rgMy poragNien so- PERMIT FEE <br /> Additional Fq~FM•... .... .- <br /> Sewer Tap DepoNl .................................... <br /> TOTAL DEPOSIT ........... S= <br /> Building Permit No. <br /> Improvement Plan No. <br /> Supplemental Conditions: <br /> !Meir WMA AM*N#6111.OD drawing wbx"w <br /> L&ApoRTANT' ApPOWN hereby ogrees to comply with ail provisions of this <br /> nesolutiorrs, gandon�ds and permit as writ as all applicable City ordinances, . <br /> specifkations currently in effect, and to pay to City Its actual cost for removal and proper replace- <br /> nrent of any Nun which does not meet above requirements. Failure to comply will be cause for revocation of permit. Appli- <br /> cant agrees to indetrtrtify and hold the City harmless against any and all losses, costs, or damages resulting from injury to <br /> P@(sW'k dead' of Pelson or damage to property occurring at the site of or as a result of work to be performed under this <br /> pwmlt. Gntificose of Insurance will be presented by applicant upon request, <br /> dead Gowal P wkd ws an reverse side of We permit before s <br /> !N-i1Ri0 <br /> sion.a, Note `ment ntlf� l reoloa rl,da,.n;pea?? om- <br /> /fir) <br /> 9444M ✓��/moi'(/ <br />