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CA ZIP CIS 74,5— State: City: <br />f3y.. <br />:1 ' <br />2'1 .;O:i <br />'*1 ; 31.1". POT 5$ <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />Encvo&rJ ofrl 0.-\- -3\ 0 \^1•F'elevcsfr- "+) \Ack/v)1.- 11c),-N, /‘ <br />1-6 Co So:4, CtY-21,+ ,ibkx)A p;k.{4 ?)-4•E <br />bi -44 <br />Show sketch or refer to attached Drawing <br />5;i--cAA44 <br />04 v..). F-vewr erl <-54- <br />ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY <br />CorNISULT114(1 Date: 3 <br />Address: 3845 ATP) E.1--rni..1 20AD <br />Phone: CMP 10 3C180 E-mail:C°9:::Lr+/11 -1 )^'° <br />1.5 <br />, CITY OF <br />STOCKTON <br />arifirke, <br />Applicant: SIAN <br />Permit Number <br />EP40-0172. <br />Base Permit Fee <br />Additional Footage Fee <br />Special Conditions: <br />'2E5-17214-1.- Via044. )40010 712 <br />,for/— 3/4f <br />;tog MOteitz7749,41 C‘wfixtei- <br />7-09-459-i2-82. <br />1RTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, Standards and <br />ications 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 />Iments. Failure to comply will be cause for revocation of this permit. Applicant agrees to indemnify and hold the City harmless against any and <br />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 />ed under this permit. A certificate of insurance shall be on file with the City Risk Manager prior to issuance of this permit. <br />$ 0-3 <br />VORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE <br />NTROL NUMBER, THE CONTROL NUMBER WILL BECOME INVALID <br />PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. PRIOR TO <br />IRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE SIDE OF THIS <br />RMITTEE SHALL CALL INSPECTIONS AT (209) 937.8381. <br />1AL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />Misc. <br />Misc. <br />Misc. <br />Total <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 oi <br />the most current version of the City of Stockton Storm Water <br />Pollution Prevention Maintenance Staff Guide, whichever is applicable. <br />Date: C-341,06 <br />Expiration: o///e <br />>- <br />0 <br />LU <br />`O- <br />Associated Permit(s): <br />Official Use Only <br />Sign <br />Print CeR-1/ 1 /4 / we e-r-GeAAANI <br />Completion Date: <br />Ac a <br />lINTION. Ap icant/Contractor- you are responsible to-ft place all broken, damaged, <br />&V/e aNpf V&A( k(--- Oft. <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: 310 14125 1 Ral\OPN't1:67--Apprax. . <br />Start Date 4/-/IE3