Permit Number
APPROVED: BY THE DEPARTMENT DIRECTOR
Subject to the General Provisions and Special Conditions, and all work must conform to the project's approved Storm Water Pollution Prevention Plan or the most current version of the City of Stockton Storm Water Pollution Prevention Maintenance Staff Guide, whichever is applicable.
By: Date:
Associated Permit(s): Expiration:
I (or we) hereby apply for an Encroachment Permit to carry out the following work:
ATTENTION: Applicant/Contractor- you are responsible to replace all broken, damaged, and/or raised sidewalk, curb and gutter from score mark to score mark adjacent to the parcel; remove USA markings upon completion of the permitted work.
IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable city ordinances, resolutions, Standards and 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 requirements. Failure to comply will be cause for revocation of this permit. Applicant agrees to indemnify and hold the City harmless against any and 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 performed under this permit. A certificate of insurance shall be on file with the City Risk Manager prior to issuance of this permit.
IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE
OF A CONTROL NUMBER, THE CONTROL NUMBER WILL BECOME INVALID AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. PRIOR TO
ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE SIDE OF THIS PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (209) 937·8381.
READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE SIGNING. Print
Sign
Show sketch or refer to attached Drawing
Base Permit Fee $
Additional Footage Fee $
Misc. $
Misc. $
Misc. $
Total $
Special Conditions:
ENCROACHMENT PERMIT
ON PUBLIC RIGHT-OF-WAY
Applicant: Date:
Address:
City: State: ZIP:
Phone: E-mail:
WORK LOCATION:
Start Date: Completion Date:
OFFICIAL USE ONLY
Official Use Only
PERMIT NOT VALID WITHOUT A
CONTROL NUMBER
CALL (209) 937-8366 TO REQUEST A CONTROL NUMBER NO LESS THAN
24 HOURS, BUT NOT IN EXCESS OF 72 HOURS PRIOR TO START
OF WORK.
CONTROL # __________________________
Kari Hernandez
Neighborhood bounded by W Hammer Ln Frontage Rd, Kelley Dr, and Richland Dr. Also includes Shoreham Pl
STREETS IN MORATORIUM: KELLEY DR, RICHLAND DR, SHOREHAM PL WORK DURATION -30 DAYS
Contact Christina Barreto Public works for required field meet prior to
start at 209-937-8412
Call for control number after field meet 209-937-8366
Worksite must be USA'd prior to required field meet with Public
Works Pothole all utilities
Install & RESTORE TO MORATORIUM STANDARDS
72hr no parking notice
coordinate with all property owners affected
42” min cover on street crossing
Must maintain an ADA path of travel at all times
8:30am to 4:30pm
<--- SEE LEFT
BORE PATH SUBJECT TO PW INSEPCTION AND
APPROVAL
EP23-0985
06/07/23
10/29/23
547.00
TECH FEE
CRS FEE
TRENCH FOOTAGE: 3,034 LF
BORE FOOTAGE: 22,547 LF
TOTAL FOOTAGE: 25,581 LF
6,262.21
5,011.37
94,798.33
82,975.75
AT&T CALIFORNIA-VALLEY PERMIT DESK
12/31/2022
1445 VAN NESS AVE
FRESNO
CA
93721
559 552-4608
[email protected]
06/01/23
09/29/23
PLEASE SEE THE ATTACHED PERMIT DRAWINGS FOR
AT&T JOB# A02EB6P.
7104, 7250, 7328, 7378 KELLEY DR; 2803 SUMAC
AVE; 2805 JASMINE AVE; 2803 BONNIEBROOK DR
DIG (196)4'X4' PITS, DIG (119)4'X6' PITS, DIG (62)2'X2' PITS, PLACE 14430' 1-4" DUCT VIA BORE, PLACE 313' 2-4" DUCT VIA BORE, PLACE 93' 3-4" DUCT VIA BORE, PLACE 7411' 1-2" DUCT VIA BORE, PLACE 161' 2-2" DUCT VIA BORE, PLACE 26' 3-2" DUCT VIA BORE, PLACE 733' 1-4" DUCT VIA TRENCH, PLACE 856' 2-4" DUCT VIA TRENCH, PLACE 113' 3-4" DUCT VIA BORE, PLACE 1247' 1-2" DUCT VIA TRENCH, PLACE 177' 2-2" DUCT VIA TRENCH, PLACE 21' 3-2" DUCT VIA TRENCH, PLACE (85) FLOWERPOTS, PLACE (28) NEW
10"X15"X12" SPLICEBOXES. SEE ATTACHED DOCUMENT FOR MORE WORK DESCRIPTION FOR AT&T JOB# A02EB6P.
ATTACHMENT A