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4 `- ty� °Ft�O, CITY OF LODI FENCROACHMENT PUBLIC WORKS DEPARTMENT221 W. PIN E ST. 333-6706PERMIT CALL BOX 3006 LODI, CALIFORNIA 95241.1910 F dress Vicinity 1420 S. Hutchins & 1340 S. Hutchins St. 's NameBROWN & CALDWELL PO BOX 13449, Sacramento, CA95813- ontractor} Address449 ate Completion Date License No. Phone (916)444-0123 ntractor Steve Misner Address Phone 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 work; NOTIFY USA (800) 642.2444 48 HOURS PRIOR TO ANY EXCAVATION. The work consists of drilling soil borings and installing monitoring wells in area at rear of sidewalk; locations as shown on site plan. (Attached) No drilling or borings in sidewalk, if possible. Backfill per work pian: cement grout mixture with 3" asphalt Traffic control per Cal Trans Traffic Control Manual 1990. Note item No. 6,"General Provisions" public. "Sidewalk Closed" signage and barricadesrequired at work site and at nearest crosswalks. Acquire consent from property owners affected by work to be done at sites as shown on plan. Permit void if work not started within 6 months of permit date. (Space For Sketch) ❑ Licensed Contractor required for this work. I Certificate of insurance in the owner's name which names the City of Lodi as an Additional Named insured for Com- prehensive General and Automobile insurance in the amount of $1,000,000 combined single limit is required. --- The undersigned does hereby agree to indemnify and save the City of Lodi free and harmless from any liability,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 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 ail other costs and fees in accordance with the provisions of Sec. 12.04.120 of the Lodi Municipal Code. QQ Date �(��I� ,. ,._ Signed rReviewed 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 pravi- Ins. Brokers San Francisco, Inc. Bions as shown on the reverse side. te of InsuranceVQ847' 25 13-0� 3/26/95 en. Policy No. xp. Permit Approved: CITY OF LODI ive Policy No. �� Exp. 3/26/95 By: to GARY MURDOCK (333-68361te ❑ Public Above Ground Date d Date ❑ Public Underground ed Date INX Private, to be maintained or relocated by owner as required.. Date 0 Other Permit No.