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r. Permit Number <br /> IMY OF E,,, CROACHMENT PERK.1 e77633 <br /> STOCKTON1r ,nON PUBLIC RIGHT-OF-WAY <br /> Applicant: Hf�J�^'t1(� 6(0 GYIU Y++t.yw�Date: z�I J APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Z Subject to the General Provisions and Special Conditions,and all work must <br /> .1 cl conform to the project's approved Storm Water Pollution Prevention Plan or <br /> QZt/ID.ry) <br /> Address: VV JJ .J (4,3 ,mit he most current version of the City of Stockton Storm Water <br /> C�yPollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: ✓ `"GIS' State: `-- ZIP: 4 S z r Q <br /> I <br /> LL By: Date: <br /> Phone: 2ap ` 4G-7- 1000 E-mail: IMGIO&Q V J <br /> A t.Yl, <br /> R �ssociatedPermit(s): �7Expiration: <br /> WORK LOCATION: k ,i .:v+k c WPA 51 ' F-Ify <br /> N �M's 'A� <br /> [art Date: Oe 1 7 7p, 1`4 Completion Date: �O 0 70) s .l. (7.G3) 937-8 5 TO�. QU SY d, COST ' <br /> MUNzMR NO LESS THX4214 ` fRS, BU`( WT IN <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, EIME�.S-rS OF 72 HOURS PRIOR TO STAR OF WOM <br /> and/or raised sidewalk,curb and gutter from score mark to score mark adjacent to the <br /> parcel;remove USA markings upon completion of the permitted work. <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> AdoeA Stu& l-( 1CA .a, (4) Q) ltf 1CC4A bo n%5 � Co l(t ra„ a'( <br /> SOI� ✓bta1c)L-_x kT4 S ^O ICS . �)t 0,A kCe u1e,.�f ��j« ht p oto--an-CA <br /> d r\rcCF v vSk.. 4 'cr:ll at f r i I 15 1 f r ll)s. <br /> Show sketch or refer to attached Drawing Official Use Only <br /> Base Permit Fee $ 5 tis-0 <br /> Additional Footage Fee $ <br /> Misc. lar $ 1L3 <br /> Misc. I $ 10 <br /> Misc. $ <br /> Total $ <br /> Special Conditions: <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 <br /> ANY REQUIRED INSPECTIONS,AS IDENTIFIED ON THE REVERSE SIDE OF THIS Sign / <br /> PERMIT,PERMITTEE SHALL CALL INSPECTIONS AT(209)9378381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE (� <br /> SIGNING. Print ck ty 11 <br />