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12-01-2000 3:01PM FROM CITY OF LATHROP 229 858 1023 R.3 <br /> PUBLIC WORKS DEPARTMENT' N2 208 <br /> Lathrop, <br /> South Howland, Suite 1 <br /> Lathrop, California 95330 <br /> (209) 858-5592 <br /> Fax 8583259 -�1 <br /> ENCROACHMENT PERMIT <br /> TO: Name lT Caroora im Date Issued 11/13/00 <br /> Address 3939 Cambridge Rd., ►220 Contractor IT Corporation <br /> Camara Park, CA 95682 <br /> Phone 530476-68M Phone 520-676-6884 <br /> (Permittee) <br /> Date work to begin License No. 137422 <br /> PERMISSION IS HEREBY GRANTED TO: <br /> See attached supplemental <br /> (Attach 1 set of plans or sketches) <br /> to do work in City right of way as shown on attached application and subject to all the <br /> terms,conditions and restrictions written below or printed as general or special provisions <br /> on any part of this form, and/or attached hereto. <br /> Your attention is directed to the general provisions printed on the back of this form This <br /> permit is to be strictly construed and no work,other than that specifically mentioned above, <br /> is hereby authorized. <br /> This pe�znit shall be void unless the work herein contemplated shall have been completed <br /> by dG(�t ( r IX ZLoI. <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement <br /> to all the conditions and requirements of this permit /^ <br /> Signatu of Permittee Director of Public WorksBrtL� By: <br /> 1VVJ <br /> n <br /> Permittee or Authorized Agent <br /> PERMIT IS NOT VALID UNLESS EXECUTED BY DIRECTOR OF PUBLIC WORKS OR <br /> HIS AGENT. <br /> WHrr FP inee YELLOW-Accounting PINK-File <br /> 8. The applicant shall provide USA with proper notice prior to final location and construction <br /> of the well. The City shall have final decision on location of the well. <br /> 9. Applicant's Contractor shall provide the City with a copy of their insurance with the City <br /> of Lathrop named as an additional insured and a copy of their Worker's <br /> Compensation Insurance. <br /> 10. Applicant's contractor shall provide the City with 24 hours notice prior to any work <br /> with the public"Right of Way". <br /> „_I I'. AM11=1 shall provide the Cily 01 LathrOp with 24 hours n00Ce priar to flay telling 01 the <br /> wells. <br /> cc: Michael J.lnfuma,Jr.,Senior Registered Environmental Health Specialist <br /> San Joaquin County Environmental Health <br /> C',�My Oen+DhNORMRNCx CHMM PFAmtrcoNDnimw(uq fmnd nA ilrn. <br />