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' I Cityof LodiENCROACHMENT Public Works Department PERMIT Permit Address 712 S. SACRAMENTO STREET Date: 10/21/2009 Applicant's Name, Address Phone 925-299-9300 Stantec-Mason Albrecht 57 Lafayette Circle,2nd fir, Lafayette, CA 94549 Cellular Starting Date 11/02/2009 Completion Date 07/30/2010 License No 710079 Phone Contractor Woodward Drilling Address 550 River Road,Rio Vista,Ca 94571 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 following: NOTIFY USA(800)227-2600 48 HOURS PRIOR TO ANY EXCAVATION. MARKINGS MUST BE REMOVED UPON COMPLETION OF WORK. Work Description: EXTENSION OF PERMIT DUE TO ADDITONAL WORK: single direct push locations and five air knife work locations. The work consists of 2"(diameter) soil borings to a maximum depth of 15 feet below ground surface by direct-push to collect soil samples at eight(8)boring locations on the western side of Sacramento Street between Tokay and Vine Sts @ 712 S. Sacramento Street. Sidewalk repair to be completed as per City of Lodi Standard Plan#117 and City of Lodi design standards. 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. Sidewalk to be closed; "Sidewalk Closed Ahead"signs to be placed at nearest crosswalks; barricades required at work site. 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(;ITY INgPFC'TOR .IFRRY nFWAI T AAA-RRAR AT RTART OF WnRK Prnnar nntifinntinn of Permit void if work not started within 6 months of permit date. El Licensed Contractor required for this work Conditions Attached Plans Attached W 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 In the amount of $1,000,000 per occurrence and Automobile Liability Insurance in the amount of$1,000,000 combined single limit. 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 0 7/3 01201 0 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 InsurancePerm' )4pproved: CITY OF LODI AON Reed Stemhouse, Inc. lI Comp.Gen. Policy No GLO 3373919-0 Exp _ 05/01/2010 By / / Automotive Policy No Exp ❑/ Public Above Ground Date Other Policy: Exp © Public Underground Referred to Jerry Dewalt Date - ❑ Private,to be maintained or relocated by owner as required. Inspected _ Date © Other Permit No. 2009-159 Completed id Date 12/11/2009 Reviewed Date Fee: $485.00 d❑ Paid Inspector Copy ❑File Copy ❑Permittee Copy PWD-002(Rev.6/97)