Laserfiche WebLink
ENCROACHMENT PERMIT Permit Number <br /> CITY OF <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY f�p�� �Q <br /> APPROVED: BY THE DEPARTMENT DIRECTOR <br /> Applicant:' fc'� s t+' ( M L Date: `/ Z Subject to the General Provisions and Special Conditions, and all work must <br /> Address: conform to the project's approved Storm Water Pollution Prevention Plan or <br /> . 0�7 / i/ �,� �]GI ;' �fs_ � LU <br /> vt he most current version of the City of 5tockton Storm Water <br /> Pollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: � � ;'`f f State: �� ZIP: y Cr Q �s <br /> pv_ � Date: 6,45,,// <br /> Phone: la ' T L E-mail: p <br /> ssociated Permit(s): Expiration: <br /> WORK LOCATION: � � � :lfr AV e-- (�A <br /> // t.ERco3" M:'} �0t <br /> fOUTA <br /> Start Date: Completion Date: pS1361--4-y— _ <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, CALL {�wFt� 93`'-2 TO REQUEST i A CONTROL <br /> and/or raised sidewalk,curb and gutter from scare mark to scare mark adjacent to the rol e` J40 Imo.v i"r I`� NOT , <br /> parcel;remove USA markings upon com letion of the permitted work. 4�u": o sr LIOUrRS PRIG R TO START CSF t�ORI{. <br /> P g P A , ' <br /> �e@Latta` ,®� --- <br /> I(or we)hereby apply for an Encroachment Permit to carry outthe following work: <br /> o y W e-r l Mau JS J 4,v e_4.thl z>_ t 1 4 a s 5Yo r•r� t�lr �: �,��s <br /> 6-c__ A'e- 4 .v o2 5�= f7Lfflf ug= <br /> Show sketch or refer to attached Drawing / Official Use Only <br /> rr 7 <br /> Base Permit Fee $ �'��jr elt_/ <br /> jG dYr�►� ©� — 1 fh3�I� �r1 Additional Footage Fee $ <br /> �L 1. � � c1 �F��T! Misc:i, ,r,oLa � <br /> CM isc. `�� t►�r1 {n Q� S <br /> -� Misc. $ <br /> ✓f/' ^P f2 PSL [ Total <br /> $ 1 <br /> Special Conditions: <br /> ce� --fin-cad��Sr�b ► e�br rnu�s+— �l <br /> �aR q37-834 -to m4AP_rt�— <br /> Xf impar*in9 IIps" sop, eov,+Pxf' vveilejl Fell oftAp,r c <br /> 12T-P) -fV +ei"rW-An rdVt#.fer NS 5)bp Zai- JV5 51 , call '?,a hcwi pnbr - ss4*yi" <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)937.8381. <br /> READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br /> SIGNING. Print <br />