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l � City of Lodi ENCROACHMENT Public Works Department PERMIT Permit Address 712 SOUTH SACRAMENTO STREET Date: 05/30/2012 Applicant's Name, Address Phone 925-408-8151 _ TERRA PACIFIC GROUP 13900 ALTON PARKWAY SUITE 122, IRVINE,CA Cellular 9259516000 X333 Starting Date 06/04/2012 Completion Date 06/29/2012 License No 885321 Phone Contractor Address Cellular Pursuant to the provisions of the Lodi Municipal Code,the undersigned applies for permission to excavate,construct,and/or otherwise encroach on City Street Right-of-Way or Easement by performing the fallowing: NOTIFY USA(800)227-2600 48 HOURS PRIOR TO ANY EXCAVATION. MARKINGS MUST BE REMOVED UPON COMPLETION OF WORK. Work Description: The work consists of 8" (diameter)soil borings to a maximum depth of 60 feet below ground surface by direct-push to collect soil samples at NINE (9) boring locations as per attached plan. Five in the southbound lane and 4 in the northbound lane @ 712 S. Sacramento Street. Backfill shall be per Std Plan No. 506; asphalt concrete replacement shall be existing plus 1 inch; minimum of 3 inches A.C.; match finish grades. Landscaped and turf areas to be returned to a like or better condition. Applicant responsible for replacement of damaged plantings and sprinkler systems. Access to dwys shall be maintained at all times. Permits, certificates, licenses as required from affected agencies shall be acquired prior to start of work. Traffic control shall be per Caltrans Traffic Control manual. No foreign material to enter City storm drain system; all excess and pumped material shall be properly labeled, contained and removed from site. CONDITIONS ATTACHED ARE A PART OF THIS PERMIT. NOTIFY CITY INSPECTOR, JERRY DEWALT, 333-6836,AT START OF WORK. Proper notification of businesses/residence shall be completed prior to start of work. ALL USA MARKINGS TO BE REMOVED UPON COMPLETION. Permit void if work not started within 6 months of permit date. ❑d Licensed Contractor required for this work R-1 Conditions Attached Plans Attached ❑Certificate of insurance in the owner's name which names the"City of Lodi,its elected and appointed Boards,Commissions,Officers, Agents,Volunteers and Employees"as an Additional Named Insured is required for Comprehensive General Aggregate per occurance and Automobile Liability Insurance in an amount determined by Risk Mgmt. The undersigned does hereby agree to insure,indemnify and save the City of Lodi free and harmless from any liability as set forth in attached City of Lodi Insurance Requirements and in accordance with the provisions of Sec.12.04,040 of the Lodi Municipal Code.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.If the work for which this encroachment permit has been Issued has not been completed by 06/2912012 the City of Lodi shall have the right to complete the work,and to file a Cause of Action to recoup the City's expenses in 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. Signed: REFER TO APPLICATION Required Improvement Security This permit is granted subject to all 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 PP pproved: CITYOF LODIComp.Gen. Policy No Exp BAutomotive Policy No Exp Above Ground Date C f Other Policy: Exp ❑ Public Underground Referred to DeWALT/STREETS Date 06/04/2012 nPrivate oto be maintained or relocated by owner as required. Inspected Date Permit No. 2012-062 Completed Date F1 Other _ Reviewed Date Fee: $454.00 W Paid I Inspector Copy I ;File Copy _J Permittee Copy PWD-002(Rev.6/97)