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0 Pr<oo CITY OF LODI ffEN7CROACH MENT <br /> PUBLIC WORKS DEPARTMENT <br /> 221 W. PINE ST. 333.6706 <br /> CALL BOX 3006 PERMIT <br /> LODI, CALIFORNIA 95241.1910 <br /> ' FAPPlicant's <br /> dress 4Zq Wes�t L° -> t smote-f <br /> Name + t (SEACOR- <br /> ontractor) �c1CA �-`. �`�FMcc, AwWs1s ('�f: Address lo ' t�*��fn c�fSr. S. r'. - U <br /> / �_..._.__._ 0405 <br /> 1 ate I 12- az CompletionDate + t3 `2- License No. C51 *6)246 Phone 41s g8Z-15ysntractor s � r"t Ex lora s�! Sf�ckfo��C� <br /> P e -- Address ZB-25 M rile �S7A Phone `f 4bS-$712 <br /> ' Pursuant to the provisions of the Lodi Municipal Code,the undersigned applies for permission to excavate,construct,andfor otherwise encroach on <br /> City Street Flight-of-way or Easement by performing the following work: <br /> NOTIFY USA (800) 642.2444 48 HOURS PRIOR TO ANY EXCAVATION. <br /> ' I The wore", Consists of <br /> 71�s II 0>7 e 5O �4 PROPER SIGNING AND BARRICADES <br /> 2_- 11%CL, <br /> ,o►yt G rvvt1d.V 4e Vi,40 io" b REQUIRED PER CAL TRANS TRAFFIC <br /> CONTROL MANUAL 1990. SIDEWALK <br /> CLOSURE REQUIRES PROPER SIGNIN <br /> AT SITE AND ADVANCE SIGNING FO <br /> +vC,C- MOVIAW rl ) i!n:±, TI(AVELING PUBLIC. <br /> NOTIFY CITY INSPECTOR (GARY MURDOCK 333-b836) <br /> IF WORK NOT COMPLE ED, <br /> AT START OF WORK. INSTALLATION OF WELL AT 5 ' UPDATED POLICY PRIOR TO 1/19/9 3 <br /> REQUIRED. <br /> REQUIRED AT TIME OF WELL ABANDONMEN . <br /> Permit void if work not started within-'6-m-ont'hs of permit date, (Space For Sketch) <br /> ,,2- Licensed Contractor required for this work. <br /> ' Certificate of insurance in the owner's name which names the City of Lodi as an Additional Named Insured for Com- <br /> prehensive General and Automobile insurance in the amount of$1,000,000 combined single limit is required. <br /> 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. <br /> 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 <br /> future construction requires such relocation. <br /> !f the workthis encroachment permit has been issued has not been completed by the City <br /> of Lodi shall have the right to complete the work,and .euse of Ac!i n to recoup the City's expanses in complcting the work and for all other costs <br /> and fees in accordance with the provisions of Se . 12.04.120 t the Lodi unicipa Code. <br />' �:Date_!A_2-_1�1)---- Sign ed 5�74G0 R- <br /> Required Improvement Security This permit Is granted subject to all provisions of Chapter 12.04 of the Lodi <br /> Municipal Code and to all general provisions and applicable special provi- <br /> Bions as shown on the reverse side. <br /> Certificate of Insurance <br />' Comp.Gen. Policy No. Exp. Permit roved: CITY OF LODI <br /> Automotive Policy No. Exp. <br /> By <br /> Referred to GARY_MURDOCK Date ❑ ublic Above Ground Date <br /> inspected Date ❑ Public Underground <br /> Completed Date Private, to be maintained or relocated by owner as required. <br /> Reviewed Date Other Permit No. <br /> 5190 - 500 While-Inspector Yellow-File ink•Perrrittee Abrahamson Printing <br />