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DCitI(y of Lodi Public Works Department ENCROACHMENT PERMIT Permit Address 301 West Kettleman Lane (Former Chevron Station) Date Applicant's Name, Address Phone Getttler-Ryan, Inc , GeoStrategies, 13164 Gold Camp Drive,Ste 240,Rancho Cordova, 95670 Cellular Starting Date Completion Date n1a License No Phone Contractor V & W Drilling Inc Address P O Box 51, Rio Vista, CA 94571 Cellular 12/2011999 (916)631-1300 (707)374-2815 Pursuant to the provisions of the Lodi Municipal Code the undersigned applies for permission to excavate construct and/or otherwise encroach on City Street Right of Way or Easement by performing the following NOTIFY USA (800) 227-2600 48 HOURS PRIOR TO ANY EXCAVATION Work Description The work consist of installation of (3) monitoring wells within theubp lic_rl, right-of- way r the submitted work plan attached. Wells shall be Installed t the back of walk with 18" asphalt concrete apron, finish grade of apron shall match well frame and cover and slope away from well aperture Traffic control shall be per Caltrans Traffic Control Manual. current issue, one way traffic shall require flaggers. no foreign material to enter City storm drain system. all excessand-pumpedmaterial shall We propgrlylabeled, contain d and removed from site Sidewalk to be closed "Sidewalk Closed Ahead" signs to be placed at nearest crosswalks, barricades required at work site, Access to driveways shall be maintained at all b Aftlermits certificates licenses as required from affected_ agencies anda{� rties shall be uir d prior to star#of wok NOTIFY CITY INSPECTOR, WILL MCVICKER 333-6835, AT START OF WORK Proper notification of businesses shall be completed prior to start of work. (Sketch) Permit void if work not started within 6 months of permit date Licensed Contractor required for this work Certificate of insurance In the owner's name which names the "City of Lodi, its elected and appointed Boards Commissions Officers Agents and Employees" as an Additional Named Insured Is required for Comprehensive General Aggregate In the amount of $1 000 000 per occurrence and Automobile Liability Insurance in the amount of $1 000 000 combined single limit The undersigned does hereby agree to Indemnify and save the City of Lodi free and harmless from any tiabil1y in accordance with the provisions of Sec 12 04 040 of the Lodi Municipal Code Permittee is specifically aware of See 12 04 290 thereof relating to the relocation or removal of said encroachment it future construction requires Such relocation if the work for which th* encroachment permit has been issued has not been completed by nla the City of Lodi shall have the right to complele the work and to rile a Cause of Acton to recoup the Gay's expenses in completing the work and for all other costs and fees a accordant timt� pr MS10n of sec 12 04 1l,20 of the Lodi Municipal Code Date �,� = Signed Required Improvement Security Certification of Insurance Matsen Ins Brokers Comp Gen Policy No A98AG04689 Exp 04/01/2000 Automotive Policy No BA015949503 Exp 04/01/2000 Other Policy Exp Deferred to Will McVicker 333-6835 Date Inspected Date �~ Completed Reviewed Date Date ^� This permit is granted subject to all provisions of Chapter 12 04 of the Lodi Municipal Code and to all general provisions and apphcatle special provisions as show on the attached sheet Permit Approved CITY LODI By El Pu Ic Above Ground Date ❑ Public Underground CPrivate,tobamaintainedorielocated?/owner asrequired ❑ Other Permit No 99208 Fee _ $5000 fT inspector Copy L7 File Copy 7 Permittee Copy PWD 002 (Rev 61971