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CITY OF <br />STOCKTON <br />Permit Number <br />ogn ACROACHMENT PER& <br />ON PUBLIC RIGHT-OF-WAY <br />Print 1)nik7 J. ClEotAg READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. <br />Applicant: 4A.VA:AC e 0 G--b EAv. <br />Address: 639 W , C/A -s) <br />City: S -Toc IN/ State: <br />Al voiz, <br />E-mail: 7—CUE <br />A-OV(; 11: Cs) <br />APPROVED: BY THE DEPARTMENT DIRECTOR <br />Subject to the General Provisions and Special Conditions, and all work must <br />conform to the project's approved Storm Water Pollution Prevention Plan or <br />the most current version of the City of Stockton Storm Water <br />Pollution Prevention Maintenance Staff Guide, whichever is applicable. <br />By: NittlAfk-• etUr044/24 Date: /0- <br />Associated Permit(s): Expiration: <br />PERMIT NOT VAUD vanour A <br />CONTROL MASER. <br />CALL (20) Er3742C-6 TO REQUEST A CallT-201. <br />NUER NO LESS THAN 24 HOURS, BUT ROT it4 <br />EXCESS OF 72 HOURS PAM TO START OF <br />CONTROtV OFFICIAL USE ONLY I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />AT\ v,04/1c e --rhrEf:. (3) ) b%/-1../\5 col\ \A/I SD cF 14tv-r)'50e, (Cc. I <br />D TV\ rcS Sr cc,g`c-rc.i) (y_s)../:49cvAITET SAA/p4.-) <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 <br />PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (209) 937-8381. <br />Sign <br />••...e........•••••••1•1••••••••• •••••••• <br />11111.0...}...10.09.1111111t123 • <br />Date: SP qi <br />ZIP: <br />oc <br />Phone: 3 L3 -L 51 5 <br />u' c) , Aiv - Wri son . <br />WORK LOCATION: <br />Start Date: OW01 I Li> Completion Date: 0q0)) Zo 17 <br />ATTENTION: Applicant/Contractor- you are responsible to replace all broken, damaged, <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 />Base Permit Fee $ 5 23 ,00 <br />Misc. $ 36L2.3 <br />Misc. cr..S $ 51 r3b, <br />Total $5-13,&) <br />Official Use Only <br />Additional Footage Fee <br />Misc. <br />Special Conditions: <br />Fr -- ;v1,5 2ez471211 Gol-v-174-cv-I- <br />Ta-SPI, 1144.-- at <br /> <br />ad( 0°1 -- 15-3--f2 4q <br />-rv r e44ta,S4-- coyrkv I 41,14119-e- <br /> <br />rrisP .11S of - or . <br />Show sketch or refer to attached Drawing