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t�. City of Lodi ENCROACHMENT r ' 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}601-6894c Starting Date Completion Date n/a License No - --- .. Phone (209)369-9358fx Contractor - Address ___Cellular Pursuant to the crovisions of the Loc:r lumcipal Code the undersigned applies for permission o excavate construct andlar othennse enc each on City Street Right of way or Easement .j performing We`0Rowing 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 er Workplan dated April 20 2003 Permit conditions attached area part of this Encroachment Permit Expiration of Additional Insured Certificate shall cause work to cease Necessa ermits and approval from regulating agencies and garties shall be acquired prior to start of work NOTIFY CITY INSPECTOR JERRY DEWALT 209 333-6836 AT START OF WORK 40 4.1 of� 4--ac-45 (Sketch,) Permit void If work not started within 6 months of permit date tj,1G�Io3 ve Conditions Attached Plans Atta ed Licensed Contractor required for this work Certificate of insurance In the owners name which names the 'City of Lodi Its elected and appointed Boards Commisssons 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 51 000 000 combined single limit Tre undersigned daes hereby agree to Indemnify and save the City of Lodi free and harrmess from any liability in accordance m h the pro ns+ons of Sec 12 04 040 of the Lodi Municipal Ccde Perrrnttec is specs icsily aware of Sec 12 0-3 290 thereof relating io the relocation or removal of said encroachment if future construction requires such relocation I tke work for i.^ch this encroachment permit has been issued has not been completed by nia _ the City of Lodi shall have the right to complete the work and to file a Cause of Ac ion to recoup the City s expenses in completing tiie work and for all other casts and fees in accordance with the provisions of Sec 12 04 1200 of She Lodi hiunirapal Code Date 1 LO - _ — Signed Required improvement Security This permit is granted subject to all provisions of Chapter 12 04 Of the Lodi Muntppat Code Certificatioand to all general provis=ons and applicable special provisions as show on the attached Driver of Insurance Permit Approved-CFTY OF LODI Driver Alllant Ins y Comp Gen Policy No CP0108267 Exp 071_0912004 BY Automotive Policy Na CA0101637 Exp 07/09/2004 -- -.--- Public Above Ground t✓�Date f Other policy Y Exp _ , Public Underground eferred to Jerry DeWaIV333-6836Date wls petted _ Date m - i/ Private to be maintained at relocated by owner as required Completed — �— Date— - _ Other Permit Na 2003-095 Reviewed A --_ Date - Fee N - Paid � goy