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• • <br /> CITY OF ENCROACHMENT PERMIT Permit Number- <br /> S-�T��OCK�TON Q�� ON PUBLIC RIGHT-OF-WAY 1 - 19" <br /> an <br /> Applict:///�rt sy lit U.)7 oX itu—,s LLQ_ Date: 3 > APPROVED: BY THE DEPARTMENT DIRECTOR <br /> J <br /> ii y� /� (t ^ (� Z Subject to the General Provisions and Special Conditions,and all work mus <br /> Address: 111 LOn�.. \"G\M /NQ. o ati-.-, /0�p conform to the project's approved Storm Water Pollution Prevention Plan o <br /> u .he most current version of the City of Stockton Storm Wate <br /> JPollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: �t�ttC[] State: CA ZIP: 5 ¢ <br /> ZMLu /t u <br /> /n p\ (� q�tay: Marx Ca Date; <br /> Phone:U.trl\ s�q-e 21 E-mail: GCC_,zi,�$O(.t7A,F�l CA'',Iy� 0 <br /> � ����JJ `�-� 11 Reza <br /> ^J <br /> [Associated Permit(s): Expiration: <br /> WORK LOCATION: ?W0 \hU(Y�TflC� e CONTROL <br /> �I®�T NUMBER. <br /> Wff <br /> HOU Q <br /> Start Date: ` 016 Completion Date: 2 3 CON II RRL t'961GMG ER. <br /> CALL (2(19) 937-83A6 TO REQUEST A CONTROL <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, NUT?T1!:R NO LSSS T HAN 24, HOURS, BUT NOT IN <br /> parcel;remove USA markings upon completion of the permitted work. �}'p��}�-p?,�7 HOURS hRIG�''t�G SART OF Ut�GR6<. <br /> and/or raised sidewalk,curb and gutterfrom score mark to score mark adjacent to the E"'(-c9fr�W572 HOURS <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: t-1 ?i--f�/f'•�/-�..'F_ <br /> Ak\t \.N4akA-\(� cF Sot\ 1�,c; o On[� &SCgeEe_ t weer <br /> Show sketch or refer to attached Drawing <br /> Official Use Only <br /> ,� �{-!lr'e. $Base Permit Fee 71J•(� <br /> f Additional Footage Fee $ <br /> Misc. $ M�.L <br /> Misc. WS $ 50.30 <br /> Misc. $ <br /> Total $ '.7`613 IW <br /> Special Conditions: <br /> -1Az&Ivr& auvwdol <br /> 1° AywiK, K-5;?- dan" "d <br /> ihiOYK04043 rw 0/ ikgfec4r. <br /> yr �hSP?l f`�In &&a l T&ow En�ar <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, Standards and <br /> Specifications currently in effect, and to pay to the City its actual cost for removal and proper replacement of any item which does not meet the above <br /> requirements. Failure to comply will be cause for revocation of this permit. Applicant agrees to Indemnify and hold the City harmless against any and <br /> all losses, costs, or damages resulting from injury to persons, death of person or damage to property occurring at the site of,or as a result of,work to be <br /> performed under this permit.A certificate of insurance shall be on file with the City Risk Manager prior to issuance of this permit. <br /> IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE <br /> OF A CONTROL NUMBER, THE CONTROL NUMBER WILL BECOME INVALID <br /> AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. PRIOR TO II <br /> ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE SIDE OF THIS Signe <br /> PERMIT,PERMITTEE SHALL CALL INSPECTIONS AT(209)9378381. /�` <br /> READ kGENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE Print ('l�n lie- M rA,� <br />