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OF <br /> CITY O <br /> C.NCA0ACHMENT <br /> 4rr� Ate¢ 221 W.PINE ST. 333-6706 <br /> I PERMIT <br /> CALL WX 1066 <br /> :.<... . Ool, CALIFORNIA<9524i ` j. <br /> °i <br /> rAp <br /> mitAddress N L 1 fii VICINLTY�( �GO_`S_P.E.SJ: URANTl j <br /> licarst's larfte f <br /> rtertGoniractor) --_Address L � M_ <br /> Conpletton i7ateZO <br /> t.icense Nb.• Phone` <br /> rting lea# <br /> nertContractor Address Phosuant to the`provisions.of the Lodi Mlunlolpat Gorla,.tho undersigned applies for permission to;exeayate,:eonstruet andforotfierwise encroaehony Street Right of•Way or-t asement by performing thefoltowfng cork:OtIPY U§A (Wo) 642-2444. 48 4IQURS PRIOR To ANY &CAVAT'ION. <br /> Th&*ork clo.00lsts of L <br /> s, <br /> piAC -�tE Pik t <br />( IiOTUY CITY VIS ECTOR AT START OF WORK: WILL KVICKER {333-6830. <br /> 1 <br /> Boreholes will be abandoned with cement grout to 3" below finish <br /> grace. F1111 Withonce et0Mxist. grades: <br /> Businesses cont7l gent to work s7te to be nertified mtn, 24 hours <br /> prior to Start of work. Traffic control per attached !plans. lt'7Tti=.' ?,•�_�r;t t 7�;k. tr 1 i <br /> �1 ..w7a• ...1 '.�w nr� .:fff--we `. :C 1 'S � t .. �.y'. F• F r` r' .�. <br /> . .. .. <br /> i. <br /> #8 575 <br />!; <br /> Sidewalk ent:roaoTmen:t for cin-site drilling and installation t. : <br /> OT. vapor we I I m .1.1 lude prows ons or pe estri an ;; <br /> tr ffi,r root'roo �rbg 3'tl"" rlearanf:e a _ar� ar_atus - ,- <br /> —r r"p . .... <br /> Perini#Vold if work not st�irted within 6.monfhs cif date. {Spaoe:Fo 5. Whj <br /> LIc"se.d Contractor required for this work. <br /> 9.. <br /> U Certificate of Intor8lnce In the owner s name which names the City est L644 its an.Additl6hal Named insured for Coitit= <br /> , <br /> prohe"SIV6:Generi#il:and Automat lie insurance In the amount of$1 t 00,006 Combined single timlt fs required. <br /> The undersigned tioee hereby.:agree to indemnify enc€says the City of Lodi free and harmiese;from ariy:liabiffty,.:in accordance wifh the provisi <br /> 12 04.040 oUthe I.odf fiunicipal Code,.Perfnitteri.11i apeciftaally aware of See,12,04,290 thereof'relattng to the retocatton of temoinil bf said errcroIf <br /> future constructton:.requires such:.retocatlon.. <br /> If the wcrli for which.this:encroachment permit:has-been Issued has not been completed by i trf't odi shalt:havethe rl¢ht to,complete:tfie work,and to file a Cause of Action to recoup the City's exp sus in' omplettng the:wo..rk end tor:all <br /> and fess in ticcardar±ce watt►:the prtfvlsiona of:Sec.'12,04..12(1 f Otte Lad{Mu icipal Co <br /> bate �' Si nedc+Ca1 <br /> � ----- L <br /> .. . <br /> Required improvement Security F This permit Is pranced subject to all provisions of.Chapter12.04•of the Lodi <br /> Municipal Code and:io-atf generatpibVislo. na and::appticabl9 special provi <br /> Barney & Barney Met#: 105 dons as shown on the'reverae side_ <br /> Certificate b in.suran:pe C$P6:16�37 4 01/95 } <br /> Camp ±Gin. Policy No: . __..Exp, Permit Ap:prtaveti CIt1F �7F. Lb <br /> Atat'`i. Policy inti:.. Exp. <br /> 6y, <br /> Fieferretl to'Wl- GV F-11333-6835_Date—_ Date <br /> O obit AbbYdroc) <br /> Gnd <br /> inspected Date_' <br /> 0 Public;U derground <br /> Completed. [date <br /> p XX PriYate; fo tfe:matnfalned vrrelocated bp.:owrrer.as:retfrtref.. <br /> ReviewedDates El Other permit hlo. <br /> � . <br /> w..hilwotspocrdr :yonow•lzise i lnk•Pormiupe <br />