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City of ..r Public Works Department <br /> 16775 Howland Road <br /> Lathrop Ca, 95330 <br /> (209) 858-2860 ext. 328 <br /> Permit No. 20 05 _ 32 (209) 858-1023 fax <br /> City Use Only <br /> ENCROACHMENT PERMIT Prepared By: <br /> Applicant Information: <br /> Name: Ben Wright/Secor International Date Issued: August 22, 2005 <br /> Mailing address:: 3017 Kilgore Road, Suite 100, Rancho Aordova, CA 95670 <br /> Encroachment Location: Lottie Way <br /> Contractor Information: <br /> Contractor: Cascade Drilling, Inc. Construction Manager: <br /> Address: 3632 Onec Circle License No.: C57-717510 <br /> Rancho Cordova, CA 95742 Bond? UYes ❑ No Calk Bond Ch.No. 630364 <br /> Two (2) 24-HOUR CONTACTS - NAME AND PHONE NO.: vera Chapman (916) 638-1169 <br /> (MANDATORY) <br /> Mike Stephens (916) 861-0400 <br /> PERMISSION IS HEREBY GRANTED TO: <br /> Install monitoring well onLottie Way (NW-11). <br /> Applicant shall abide by attached Caltrans 5-105 lane closure on low volume, two lane <br /> road. Contractor to contact City Inspector, Kevin Connell, at (209) 520-6914, 48 hours <br /> prior to commencing construction. <br /> To do work in the City right of way as shown on attached application you are subject to all the provisions on <br /> any part of this form, 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 <br /> strictly construed 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 completed by: <br /> August 22 20 06 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all conditions <br /> and requiremen "f this permit. <br /> Director ofPY lic Wop Signature of Applicant: <br /> I — <br /> ,� A <br /> APPLICANTS COPY <br />