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01/24/2007 16: 50 5306766005 STRATUS NO CALIF PAGE 02/02 <br /> CityQf Lodi ENCROACHMENT <br /> PERMIT <br /> •" Public Works Department <br /> Permit Address 225S, CHEROKEE LANE -VICINITY Data: 01117/2007 <br /> Applicant's Name, Addresr5 Prong <br /> Stratus Environmental/Scott Bitting 3330 Cameron Park Dr,Site 550, Cameron Park,CA Cellular (916)937-1668 <br /> Start'rna Date 01/14/2.007 Completion Date _Va Lirxnse No Phone <br /> Contractor Address Stratus Environmental ZIP CODE 95652 Cellular <br /> Pursuant to Ina provisions of the Lodi Municipal Code,the undersigned applies for permission to excavate_construct,"dior otherwi5o encroach on City Street Right-ofMay or Easement <br /> by por'forming the following. <br /> NOTIFY USA(800)227.2600 48 HOURS PRIOR TO ANY EXCAVATION. <br /> Work Doscription <br /> The work consists of installation of 3 Monitoring Wells W within the <br /> E sthound travel lane f Lodi Avenue west of Cherokee Lane and 1 in aIle <br /> north of site P.er thg attached Work P{an Plot Plan and Std Plan No. 506 <br /> includina Permit condltions attached San Joaquin Coun Health Permit <br /> required Prior to start of work. <br /> Former ARCO Serv' Station#0764 <br /> PERMIT CONDITIONS ATTACHED AREA PART OF THiS <br /> ENCROACHMENT PERMIT. <br /> NOTIFY CITY INSPECTOR WILL MCVICKER 209333-6835 AT START OF <br /> WORK. <br /> Encroachment Permit for the installation of MW-9 located <br /> in area ro osed far <br /> the future widens of Lodi Avanu on East Slde of Cherokee l ne is nota art <br /> of this work and Will be issued u n the Submittal of re wired documents. <br /> (Sketch) <br /> Permit void if work not started within 6 months of permit date. Conditions Attached [J] Plans Attached <br /> Licensea Contractor required for this worst <br /> Cartifrcate of insurance in the owner's name which names the"City of Lodi. <br /> sive Gemma nd appointed <br /> eche s Punt of si 000-Oa0 per <br /> Agents and Employees"as an Addltional Named Insured is required for Compt9Aggregate <br /> Occurrence and Automobile Liability Insurance in the amount of$1,000,000 combined single limit <br /> The unders gnetl do¢a hereby ag c=to Indsmify and sovc the City 01 Lodi free and harrnlass from any liability.in accordance wllh the prevlstons of Sec.R,Od OCa or ih¢Lodi Munt�pol <br /> nla (ht Oily of Lodi shall haUc rhe r flht to complete the wark.and to rile a CO-se el <br /> Coda Pensigne m speher'61lly rtrvara of Sec.12,04,290 thereof r>rtallnp to the relocation or remaval of sold encroachment If fUwm eonelrflon requlrea such relocaoon. <br /> It the work rot which this encroechrndnt aermit has often Iz:ued has not been coria and fietea e -- y <br /> A;Uen to recoup the Ctry's expenses In completing the work and for all other 4csis and fees In seeordanoe wit Ina proNalons o c 522 0 0l theManldpaCode- <br /> A; <br /> de <br /> Date Signed <br /> This per Is aranico subleot to all provrslon: t Chapter 12.oa of the Lodl municipal Code <br /> Required Improvement Security and to all ger*1`21 provlslcns antl epph oble speciol paovletons as ehnw on the alloahed <br /> certification of Insurance Permit Approve IT�OF ODI <br /> _Mother Lode insurance Sery/Gre C. Pyle Ins <br /> Comp.Gen- Policy No 022075561-001 Pxp 0$131!2007 BY __ <br /> Automotive Polley No 11011072564 <br /> Exp 07/01/2007 Public Abov round Dat® <br /> Other Policy: Exp ] Public underground <br /> Referred to Date IY` private.(obemalntalnodarrelocatedbyWrier asweryuftd, <br /> Data- Permit No. 2007-005 <br /> Inspected �------ <br /> ! other ...^ <br /> Completed Date <br /> Fee: ,00 .r Laid <br /> Reviewed Date_��__ <br /> inspector Copy ❑File Copy ❑ <br /> Permittee Copy pwD-01)2iRev.13lg7) <br /> Ee'd BT L9 222 607- I G0_1 d0 J,1 I D SZ:9 T Leel—VE—NOf <br />