Laserfiche WebLink
�. CITY OF LOD <br /> ( ENCROACHMDENT <br /> PI iBLIC WOR ICS DEP <br /> 221 CAL PINE ST- 333-bY06 PERMIT <br /> g� CALL BOX 3006 <br /> LOD1, CALIFORNIA 95241-1P10 <br /> I FvrmitAdG:ess �j'�//fes' �,`• L ,�• �f'1�l-ee�� <br /> Applicant's Name �ti,5,�( !c':'f/> <br /> (Owner/Contractor) Address <br /> j Starting Date_ Completion Date License No. _ Phone <br /> Owner/Cantractor &ZZ Address—_ Phone <br /> Pursuant to the provisions of the Lodi Municipal Code,the undersigned applies for pe mission to excavate,conshuct,and/or otnerw se <br /> 1 encroach on City Street Ri r-af-Way or Easement by performing the louowing work: <br /> NOTIFY USA'(@00)642-2444 _48 HOURS PRIOR TO ANY EXCAVATION. <br /> The work consists of _�l: 'r,'f_lr' <br /> i . r <br /> �f�,r��•_ •r�� ��� .�rf�L�fr��'�l`.���.-!!/fly /,'`ir/:lT��/i�l vL'i�T;C1.'i��iVi <br /> • , _/f1�rrY '�' ,,,_/ff' �/ff / F•E /-�/E�/.r yam'.-�t���_�� �L'/�1 <br /> AT ee4-V17-o>F v).a r <br /> :: ��ili�/�}'l b�?•i���Yaf/-�(//ti=.�'��C'1�1,��.� `'l rr�l1��1���it7/%�/�� .s <br /> 'f2" , /(jd� //'. ��/tf•//C. U�/ lYl/ t/r^ (Space For Sketch) <br /> Permt vol t wardolf s ar ed within 6 mont o permit date. <br /> Dirt.dust,and mud to be controlled by Permittee or City has the right to do the work and bill Owner. <br /> X. Certificate of insurance in the owner's name which names the City-6TCi7di as an AdditiF N <br /> oniamed Insured-Iftor <br /> Compre-hensive General and Automobile insurance in tate amount 11,000,000 combined single limit is required' <br /> The undersigned does hereby agree to Indemnify and save the Cil/of Lodi Iree and harmless Irom any liability.in accordance with the <br /> provisions of Sec.12.04040 of the Lodi Muricipal Code.Permittee Is specifically aware of Sec. 12,04.240 thereat relating to the relocation or <br /> removal of said encroachment if future construction requires such relocation. <br /> If the work for which this encroachment permit has been issued has not been compleled Dy the City <br /> at Lodi snail have the rigt.t to complete the work,ant-to file a Cause of Action to recoup the City's expenses in completing the work and for <br /> ori other costs and fees Irl accordance anlh the provisions of Sec. 12.04.120 of the Lodi Miiniclpal Code. <br /> Date: c� Signed' <br /> r <br /> ~ Required This permit is granted subject to all provisions 75ide <br /> ''�° �'.�-;_ •-:•��Y 01 the Lodi Municipal Code, and to all general <br /> Improvement i:'r�. _ p g <br /> Security - �� /! -�=r" 7;A-/..Ay' �' ( %applicable special provisions as shown on the revC- �../ rG /[ !�. / -Z'F,rl. permit Approved:CITY 05-LQDI <br /> Cert. of Insurance ate <br /> Referred to By • - / �,�r <br /> D . Public Above Ground Date <br /> Inspected - Duta ❑ Public Underground <br /> Completed Date / <br /> / Private,10be mamramed i.r refO[afed b y owner aS reQuire17. <br /> Reviewed Date, %0%p <br /> ther Permit No. <br /> 1,17-300 HI-ffi.Kt- 2n7-Fila ]10•P-14.s LORI PRINYING Co. <br /> CAWr <br /> E TO 6I <br /> of ' i-GL ' <br /> t <br /> 6MITICSr <br />