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1 <br /> • <br /> CITY OF RIPON -ENGINEERING DEPARTMENT NO. 4012 <br /> 259 Nortb Wilma Avenue,Ripon,CA 95366 <br /> 209/599-2108—Fax: 209/599-2685 ����/ <br /> ENCROACHMENT PERMIT <br /> Applicant's Name: Nestle USA, Inc. DateSubmitted: November 15,2011 <br /> 800 North Brand Boulevard Gregg Drilling(CPT Contractor) <br /> Glendale,California 91203 Contractor: 950 Howe Road,Martinez, CA <br /> Nestle Consultant/Authorized Permit Agent: <br /> Address: Environmental Cost Management,Inc.(ECM) Phone: Gregg Drilling(Contractor):925-313-5800 <br /> 3525 Hyland Avenue,Suite 200 <br /> Costa Mesa,CA 92626 Contact Name: ECM:Binayak Acharya <br /> ECM Manager:atnayak Acharya:(661)255-1693 <br /> Phone: ECM Invoicing: Mona Mansell:(714)662-2759 License Number: Gregg Drilling C-57 License:485165 <br /> Pursuant to Chapter 12.12 of the City of Ripon Municipal Code and all the terms,conditions,and restrictions <br /> written below or printed as general or special provisions on any part of this form,and/or attached hereto. <br /> PLEASE READ THIS PERMIT CAREFULLY AND KEEP IT AT THE WORK SITE. <br /> DESCRIPTION OF PROJECT: 1.Provide a j ll description of work to be done at all locations. <br /> A PERMISSION ISHEREEYGRANTED TO 2.Attach nvo(2)sets ofplansorsketcbes, ifopplicable. <br /> Advance nine(9)2-inch CPT points in the Iocalions depicted on attached figure(4 primary locations/5 contingency),to a depth of-180 feet. <br /> Earth of 1he CPT palrag representstwo h Initial h h for lillinlriny And a qPwrand brarehnin for graindwalar samplingsdi I h I Illhology. <br /> Drilling method is truck mounted CPT rig.All holes will be grouted per S.J.County requirements under County permit.Each borehole will be advanced <br /> in the locations shown to the City of Ripon Inspector during the November 15,2011 field visit(also see attached map).Locations are In Rows,except one <br /> boring(CPT-38/contingency)on a Cily-ownedparte. A private locatin%company will mark out the street areas,along wilh mar -ouls rom USA North. <br /> ECM will follow the traffic control plan prepared by Safe T Lite and attached.ECM will also obtain road signs from Safe T Lite.The payment accompanying <br /> this permit is for the 4 primary boring locations The 5 contingency borings will be billed individually,if drilled.at$337.05 additional Permit fee per boring. <br /> Estimated Value of Right-of-Way Work: $ 19,260 <br /> Permit Fee: 3%Plan Review: $ 577.80 $4,815 per boring for 4 borin <br /> (adochad bad;up is for to total, <br /> 3% Site Inspection: $ 577.60 Incfudmt,oaeon Privnlo prop or and <br /> P 5 conlingercy bongs which will be <br /> 1% GIS: $ 192.60 paid sowmlaly.( <br /> TOTAL FEE: $ 1 ,348.20 <br /> TO ARRANGE FOR AN INSPECTION, PHONE 209/599-2108 AT LEAST 48 HOURS PRIOR TO CONSTRUCTION. <br /> This permit shall be void unless the work herein described is completed by: <br /> Date <br /> Accepting this permit or starting work herein described, shall constitute acceptance and agreement to all the <br /> conditions and requirements of this permit. <br /> Signature of Applicant/Permittee City Engineer(or authorized Agent) <br /> Applidam/Permitleb or Authorized Agent Date Issued <br /> NOTE: Your attention is directed to the general provisions printed on the back of this form. This permit is to be strictly construed <br /> and no work,other than that specifically mentioned above,is hereby authorized. <br /> PERMIT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT <br /> WORK COMPLETED: BY: <br /> Date <br />