ARCHIVED REPORTS XR0001845 - Laserfiche WebLink

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City of Lodi ENCROACHMENT Public Works Department PERMIT Permit Address 521 North_Cherokee Lane - Monitoring Wells Date 07/21/2003 Applicant's Name, - Address Phone (209)369-9421 Stephen G Muir _ P O Box 152`Woodbridge,CA 95258-0152 Cellular (209)801-6694c Starting Date -� Completion Date N8 License No T ._,, W _ ----- - Phone (209)369-9358fx Contractor - Address -'- _ Cellular Pursuant to the provisions o!she Lodi f lunlcipal Code the undersigned applies for permission to excavate construct andfor otherwise encroach on City street Right-of-way or Easement L�perfomung the fallowing NOTIFY USA(800)227-2600 48 HOURS PRIOR TO ANY EXCAVATION Work Description The work consists of installation of monitoring wells at back-of-walk south side of MurrayStreet per Workplan dated April 20 2003 Permit conditions attached area part of this Encroachment Permit Ex iration of Additional Insured Certificate shall cause work to cease Necessgy permits and agpiroval from regulating agencies and parties shall be acquired prior to start of work NOTIFY CITY INSPECTOR JERRY DEWALT 209 333-6836AT START OF WORK • r OF C—ae-475 S�Lx t t W� (Sketch) irM Permit void if work not started within 6 months of permit dateV-db1.'"LConditions Attached Plans Atta ed Licensed Contractor required for this work Certificate of Insurance in the owner's name which names the 'C"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 Tae undersigned does hereby agree to Indemnify and save the City of Lodi free and harmless from any hab,idy in accordance vnlh the provisions of sec 12 04 040 of the Lodi Municipal Ccde Permittee is specifically aware of Sec 12 04 290 thereof relating to the relocation or removal of said encroachment if future construction requires such relocation I the work for which this eneroaChment perms.has been issued has not been Campteted by _iiia the City of Lad,shall have the right to complete the work and to rite a Cause of Ac,an to recoup the City s expenses,n completing the work and for all other costs and fees in accordance with the provisions of Sec 12 04 120 of the Lodi Municipal Code Date g_ Signed .41- Required Improvement Security This permit is granted subject to act provisions of Chapter 12 04 of the Lodi Municipal Code and to all general provisions and applicable special provisions as show on the attached Certification of insurance — -- v- - Permit ApproV OF LOD� Driver Allrant Ins Comp Gen Policy No CP0108267 Exp _0710912004 By Automotive Policy No CA 1017 Exp 07/09/2004 �TT Date �� Public Above Ground Other Policy Exp _ _ Public Underground �eferr tod Date to Jerry DeWalt/333-6836 Date specte �/ Private to be Maintained or relocated by owner as requrrea aT '-- Completed Date - Other Permit No 2003-095 Reviewed Date Fee $0-60 — Paid 5a - 1.....-.....a...!`.... — C r../��_ �n--..-a._- n-- n rrn nn•.�o., aen'1�