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City of ., •.� Public Works Department 16775 Howland Road Sof© �krll Lathrop Ca, 95330 (209) 858-2860 ext. 328 Permit No. 2005 - 45 (209) 858-1023 fax ENCROACHMENT PERMIT yP` aBY Applicant Information: i Name: SECOR International / PAchard Peltier. Date Issued: January, 09, 2006 Mailing address:: 3017 Kilgore Rd, Suite 100 Rancho CHrdova, CA. 95670 Encroachment Location: Mingo Way adjacent to 16416 Cambridge Drive Contractor Information: Contractor: SECOR International Clint Harms Construction Manager: Address: 3017 Kilgore Rd, Suite,i100 Rancho Cordova LicenseNo.: 654498 ,r Bond? ❑ Yes ❑ No Two (2) 24-HOUR CONTACTS - NAME AND PHONE, NO.: Clint Harms (916) 861-0400 (MANDATORY) Ed Ralston (916) 558-7633 PERMISSION IS HEREBY GRANTED TO- Complete two monitoring wells. Installations in City right of way air®approved by San Joaquinb County Environmental Health Dept. All work in the public right of way shall be in accordance with the attached approved pilins. The contractor shall notify the Contrantlinn Inspection Dept. at least 48 hours prior to beginning the work within the City right ofwway. To do work in the City right of way as shown on attached application you are subject to all the provisions on any part of this form, and or attached hereto. Your attention is directed to the general provisions printed on the back of this form. This permit is to be strictly construed and no work, other that specifically mentioned above, is hereby authorized. This permit shall be void unless the work hereunder contemplated shall have been completed by: August 01 20 06 Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all conditions and requirements of this permit. Directo of ublic or : Signature of Applicant: APPLICANTS COPY