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:l ITY <br />iS <br />• C OF <br />mu <br />STOCKTON <br />Permit Number <br />EP/ -2L1 ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY <br />NH -a\ 6 k-cue*-1CY1 <br />ciV.A\ . <br />-0-C-- 0- .(0(..6-NAI p-014 6.0) \mcAlux1Y1(.. u\;\ <br />A„licant:MV 4eddrtkiWtV Etin Date: <br />Address: Z."7 ? S\11A\Ki <br />city : State: 0-k ZIP. V4C- <br />Phone: 2'0 /).1(14- b.)40 <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />PERhliT NOT VALID WiTEGiri) A <br />CONTROL 111,103ER. <br />CALL (2C-S) 937-8366 TO REQUEST A CONTROL <br />NUMNR NO LESS THAN 24 HOURS, BUT NOT IN <br />EXCESS OF 72 HOURS PRIOR TO START OF WORK <br />CONTRO; <br />E-mail: <br />CACWW c-.2 <br />Misc. <br />Misc. <br />Misc. <br />Total <br />Show sketch or refer to attached Drawing <br />coac.o.e4 c 'Own <br />Additional Footage Fee <br />Special Conditions: Conditions: <br />/e2e371.9/e6- de5Yt/C/2e17-6- ,</1;674/4Y-k <br />c74,A,7"-7V <br />* fa-3722/67- fr1/49gk NOL/AS <br />77) - 0,44 <br />RECEN26 <br />FEB 2018 <br />ENVIRONMENT HEALTH <br />$ - - Base Permit Fee <br />Official Use Only <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 />fi <br />Print --01-4-Ol 6 \c_•er <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 Sieil <br />PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (2091937-8381. <br />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. <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 />WORK LOCATION: \PJ 1-2,0 <br />Start Date: 9-1. C?) Completion Date: .721 ‘z--1 I <br />kv•katco2c-6crY\ <br />/ 9 1;1111(.01V\ (\t,lcoAk;:,,, <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 aintenance Staff Guide, whichever is applicable. <br />Date: <br />/// <br />Expiration: 47 -247e OFFICIAL USE ONLY : <br />By: <br />Associated Permit(s):