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��=� <br /> CITY OF PNCROACHMENT PERM T •Permit Number <br /> STOCKTON ON PUBLIC RIGHT-OF-WAY 9 <br /> -1(oi <br /> Applicant: _ �t c_,V�( t"-� l-L(,. Date: r APPROVED: BY THE DEPARTMENT DIRECTOR <br /> .riX� �}U � <br /> Z Subject to the General Provisions and Special Conditions,and all work must <br /> 0 conform to the project's approved Storm Water Pollution Prevention Plan o <br /> Address: Lu��e �7n\M `�� 7tE �� ` tA he most current version of the City of Stockton Storm Water <br /> JPollution Prevention Maintenance Staff Guide,whichever is applicable. <br /> City: ( �U��C� � State: CA� ZIP: �SS4 ( Q <br /> .w• � q 20 <br /> t)i > 5-79-2221 �y 11" ` u By: Date: <br /> Phone: E-mail: �� C.Z55(�C\Ztt�.�, L(••.;�'� 0 1� Z[Associated Permit(s): Expiration: <br /> ORK LOCATION: �G�1� �z�:c_\ L /-\U"� <br /> s/.�' ' ' ' --. ��kiRmily WWI VAUL1 WIN( U`�A <br /> Start Date: `1 ` 1 1 1 Completion Date: / j 1 (� CONTROL NUMBER. <br /> Z� J CALL (209) 937-M TO REQUEST A MNWPOL <br /> ATTENTION:Applicant/Contractor-you are responsible to replace all broken,damaged, r, <br /> and/or raised sidewalk,curb and gutter from.score mark to score mark adjacent to the t�llli�'�^ER NOLESS TI qtd 24 HOURS, BUT NOT IN <br /> parcel;remove USA markings upon completion of the permitted work. EXCESS OF 72 HOURS TO START OF WORK. <br /> CHIN TROL#C.N O9 71,7II''C 0 <br /> I(or we)hereby apply for an Encroachment Permit to carry out the following work: <br /> z� � �>✓ `Z { tee; �� (�. J�.��S n � i <br /> r3, Ck L de-, Lylr��.��Uc;nQ r�r�il <br /> 4J as <br /> Show sketch or refer to attached Drawing <br /> P�!Z-f vre A,, ��' Official Use Only <br /> Ci Ay s-��,,,.�Q,e�n-�J/. 'Praw jlJ I'L� p� {� R Jr2 Base Permit Fee $ 5Z3- 00 <br /> ��✓�✓� Additional Footage Fee $ <br /> (, Misc. `tp-cff $ 31. 70 <br /> v l Misc. CA:Z& $ :?;/. <br /> Misc. $ <br /> Total $ <br /> s93 . !ol <br /> Special Conditions: <br /> �tusf Gall zD9- <br /> SWP_ cowl 414s" prAor to <br /> o'I- wcr-f e-. <br /> Sep' uP wIfi'L d,Jf f�N ikJpeG4I' <br /> — Fir ,y�spe i*o, , confi�.c�' 'J"n.3oh <br /> _1031 —IZ87-- , <br /> or � Zdq'--1� •-IZg3 <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 1 I <br /> SIGNING. Print <br />