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City of Lodi ENCROACHMENT <br /> Public Works Department PERMIT <br /> Permit Address 225 SOUTH CHEROKEE LANE Date: 11/03/2004 <br /> Applicant's Name, <br /> Address Phone <br /> URS/Mathew Farris Crown Corporate Ctr,2870 Gateway Oaks. Dr. Cellular (916)679-2054 <br /> Starting Date 11/01/2004 Completion Date 01/30/2005,-1— License No <br /> —.....,,.,�. �...---._.--...,.....�------- Phone <br /> Contractor Address Suite#300,Sacramento CA 95633 Cellular ^ <br /> Pursuant to the provisions of the Lodi Municipal Code.the undersigned applies for perrrussion io excavale,construct,ane/or otherwise encroach on City Street Rght-ol-Way yr Easement <br /> by pertor mng the(olloWngt <br /> NOTIFY USA(800)227-2600 48 HOURS PRIOR TO ANY EXCAVATION. <br /> Work Description <br /> The work consists of off-site soil-borings/groundwater investiciation as <br /> described in WorkDlpn and correspondence of October 29, 2004. Finish <br /> pavement work shall be in comoliance with City of Lodi construction. <br /> spocifications and Std Plan No. 506, T-trench will not be rgouired, <br /> PERMIT CONDITIONS ATTACHED APE A PART OF THIS <br /> ENCROACHMENT PERMIT. <br /> NOTIFY CITY INSPECTOR, JERRY DEWALT, 333-6836, AT START OF <br /> WORK, <br /> PROPER REMOVAL OF WORK-RELATED UTILITY MARKINGS IS <br /> REQUIRED. CONTACT CITY INSPECTOR FOR REMOVAL INSTRUCTION. <br /> (Sketch) <br /> Permit vold If work not Started within 6 months of permit date, d Conditions Attached lei Plans Attached <br /> i%�! Licensed Contractor required for this work <br /> id! Certificate of Insurance In the owner's name which names the"City of Lodi, Its elected and appointed Boards.Commissions, Officers, <br /> Agents and Employees"as an Additional Named Insured is required for Comprehensive General Aggregate In the amount of s1,000.000 per <br /> occurrence and Automobile Liability Insurance in the amount of$1.Oo0,00o combined single limit_ <br /> Required Improvement Security This pertrit is grained subject to all provisions of Chapter 12,04 of the Lodi Mun ctpel Code <br /> and to all general provisions and npoiieebfe speelal prodsions as show on the gi[Oned <br /> Certification of Insurance Permit Appro d: CITY OF <br /> Marsh Risk & Ins. Services <br /> Comp.Gen_ Policy No GL933-3116 _Ex_p 04/01/2005 By <br /> Automotive Policy No 826„1679 AOS Exp 04/01/2005 blic Above Ground Date �� <br /> Other Policy: - ExP ,. _- Public Underground <br /> Referred to _Jerry Dewalt— - Date Private,totip malma+ed orrefocatedbyowneeasraouired. <br /> Inspected �._ --. , oat0 _ Permit No. 2004191 <br /> Completed Date Other <br /> Fee: 8-2 00 (_J� Paid <br /> Reviewed __. Date----..,.,..,r-----� <br /> Inspector Copy ;File Copy !Permittee Copy Pwo-002 tRev.&97) <br /> Eo'd O2,9 222 60E I(10-1 j0 Al 13 9E!:b ti VOOE—T ti—TION <br />