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City of Lathrop 0 ` <br /> Public Works Department <br /> 16775 Howland Road F <br /> Lathrop, California 95330 <br /> (209) 858-2860, Ext. 328 <br /> Fax(209) 858-1023 W <br /> Supplemental to Permit No. 207 Louise Ave,) <br /> Encroachment Permit for the Insta ne (1)Monitoring Well <br /> 1. The applicant shall provide the City of Lathrop Public Works Department with a formal <br /> written acknowledgement that this is a revocable permit and that the City may revoke this <br /> permit at any time <br /> 2. The applicant shall provide the City of Lathrop Public Works Department with a copy of <br /> the County Environmental health Permit. <br /> 3. The applicant shall pay an Encroachment Fee in the amount of$120.00. (Note:the City has <br /> received a check in the amount of$120.00,which covers this amount). <br /> 4. The applicant shall post a cash bond in the amount of$2,500.00 per well to insure the well <br /> is abated. <br /> a. (1)well x$2,500.00=$2,500.00 bond required. (Note: The City has received a <br /> check in the amount which covers this amount) <br /> 5. The applicant shall pay an inspection fee in the amount of $150.00. <br /> b- Contract Inspector=$150.00 inspection Fee <br /> 6. The applicant shall provide the City with a detailed work plan showing the location of the <br /> proposed wells and pay a Plan Check Fee in the amount <br /> a. 3 hours @ $50.00=$150.00 <br /> 7. The applicant shall submit a traffic control plan for approval by the City Engineer. <br /> $. 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 /> —11r Applicant shall provide the City of Lathrop with 24 hours notice prior to any testing of the <br /> wells- <br /> cc: Michael J. Infurna,Jr., Senior Registered Environmental Health Specialist <br /> San Joaquin County Environmental Health <br /> C;�My Daumems\De4OR4\ENCROACHMENT PFeMIT CONDrl'IONSUT Carp.2 mrnilbring wallE.dne <br /> 5 -d EZO l 858 60F d0aH1V1 d0 .11 I O NOdA WdZO'£ OOOZ—I O—Z k <br />