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WORK LOCATION: 3/0 11\10)1 <br />Completion Date: <br />crCfle .4V'titn) <br />ENTION: Ap icant/Contractor- you are responsible t place 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 />Start Date: 4h1/6 <br />CITY OF <br />STOCKTON <br />arin <br />Address: 7 e3 --S ATI-IFfeTnA ?DAD <br />City: r..0cAL---LIN..) State: CA ZIP. cis vieS— <br />Phone: CP& /7/ C:iR0 E-mail: <br />Permit Number <br />EP/1-017-2. <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: 7,4- Date: C-3/2111,A013 OFFICIAL USE ONLY ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY <br />sIvvia-w <br />Applicant: SI-Ale Cor45ut2Tini1'l Date: s <br />Associated Permit(s): Expiration: <br />cm.) 074236 TO REQUEST A CAOtirROL <br />;;EA NO LESS THAW 24 WJ Rif NOT Pr C) 7 1101FitS IC 3 TA7T1 OF MM. <br />c .fe <br />enc Tio owl CA (2 01ALcA,--- -"\C) \^1 -Wevv)cvt' fvoN <br />c -1- -fi—z <br />Show sketch or refer to attached Drawing <br />AA. <br />WI /to) oy) --vevyr,rri- L51, <br />Misc. <br />Misc. dQc <br />Misc. <br />Total <br />Special Conditions: <br />-i:5-112,te-/-- V-) 4944 Womas 7v <br />to; — 3/epf <br />fiv_ceoz.7/ co,trpora- <br />009-4BR -1242. <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />Official Use Only <br />Base Permit Fee <br />Additional Footage Fee <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 />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. Print ec,{2- wive. A 4-4-eramANI