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City of ublic Works Department <br /> • 390 Towne Centre Drive <br /> "-- Lathrop Ca,95330 <br /> Front Desk (209) 941-7435 <br /> Fax (209) 941-7449 <br /> Permit No. 20 Oa-07 <br /> City Use Only <br /> ENCROACHMENT PERMIT Prepared By: ALC <br /> Applicant Information: <br /> Applicant Name: Stratus Environmental Inc Date: 3/11/2008 <br /> Mailing address: 3330 Cameron Park Drive Ste 550 city: Zip: <br /> Cameron Park 95682 <br /> Encroachment Location: Thomsen Rd and Harlan Rd <br /> Contractor Information: <br /> Stratus Environmental Inc <br /> Contractor: Woodward Drilling Construction Manager: <br /> 3330 Cameron Park Drive Ste 550 <br /> Address: Contractor Phone No.: 7m 474, inn <br /> Cameron Park 95682 <br /> City: Zip: License No.: 710079 <br /> Bond? 0 Yes;'X`No <br /> AMOUNT CHECK/BOND# Release of Bond Approved By: <br /> Two(2)24-HOUR CONTACTS-NAME & PHONE NO: Salah Sal c do 530-676-9966 <br /> (MANDATOR 19 <br /> _ <br /> PERMISSION IS HEREBY GRANTED TO: Collin Ficrhar 916_715-6115 <br /> Install two monitoring wells in the Joe's Travel Plaza area. Project is in conjunction <br /> with ground water monitoring project. Contractor shall notify the construction inspection <br /> department at least 48 hours prior to the st�rlt of t�orli wirRlldin the it right of way. <br /> Addition work: Reconstruct monitoring we s on ar an µ}t9 bNff�-Xe <br /> To do work in the City right of way as shown on attached application you are subject to all the provisions on any part of this form, <br /> and or attached hereto. <br /> Your attention is directed to the general provisions printed on the back of this form. This permit is to be strictly <br /> adhered to and no work other that specifically mentioned above,is hereby authorized. <br /> This permit shall be void unless the work hereunder contemplated shall have been com 1 ted <br /> 3/11 20 09 fXkWdett V {36v�( <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all conditions and requirements of <br /> this permit. <br /> Director of Public Works: Si a e of-kppliTant: <br /> OFFICE COPY <br />