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City of'*, l o Emcp �t Public Works Departmentp PER=ADORNS 102 North School Street DATE 4/14/99 PLICANT$NAME tQwner/ConttaeMr� ADDRESS dvance gee nvironmPntal 4005 N. Wilson Way, Stockton, CA 95205 PHONE STARTING DATE COMPLETION DATE- :!6 /� LICENSE NO._ 209.1 — n OwNEWCONTRACTOR ADDRESS ONE Kevin McKibben, Geologist Pursers to the prorgions of the Lodi Municipal Code,the undersigned applies for permission to excavate.consbuct. andfor omerwne encwch on Cay Street Rght.ol way or Eaaemept by peoftl wq the 110owthg• NOTIFY USA(800)227-2600 48 HOURS PRIOR TO ANY EXCAVATION. The work conslstsof installation of 06e ground eater monitoring well in street Dayament `-7` from face of curb) (`Work Plan, an M n t ring well to Fe flush mounted; traffic lid, RZkfii! witil iVistingI. aspliait cortcrete apron, No foreign naterial to enter storm drain system; Haste material to be stored in metal drums, flot.i-fy-ci actor at clearly label Ed and off of public right-of-way, tur_t__o.Lwzrk.:,_.._._� Traffic c of Der Cal Trans Traffic Control Curt Juran 333-6835 Manual, current issue. No vehicles on sidearalk; no open excavations, **r---pt at time work. ?ix CO Work site to be barricaded from travelling public. Work site to be cleared of all equipment at end of wart; day. Permit void if work not started within 6 months of permit date. (Space For Sketch) XX Licensed Contractor required for this work Certificate of insurance in the owner's name which names the'City of Lodi,its elected and appointed Boards,Commissions, Officers,Agents and Employees'as an Additional Named Insured is required for Comprchonsive General Aggregate in the amount of $1.000,000 per occurrence and Automobile Liability Insurance In the amount of$1,000.000 combined single limit. The undemigned does hereby agree to indemnify and save the City of Lodi tree era hamuess from any liability.n accordance with the prov"M at Sec.12A1.0t)of the Lodi Munlclpal Coda Penm4tee is spenecally aware of Sec.12.W M thereof releting to the reloQuorl at removet or said encroachment if future contdNpian reouree suen reiocation. 1f the work tar which this encrosch meat pemut has been""d res not been completed by ,the City of LOW!hall hive the right to Complete the work and Male a Cause 01 ACBon to recoup the City's examen in completing the wort and for aA other coats and tees In aeeerdance with the prwisionnc of SIC,12.114.120 M the L66 Municipal Code, Date CI Signed7T�4 t u,S xo-e ,-j— Required Improvement Security This least is granted subject to all wvvtslpna aChapter 12.01 of the Lodi Municipal Cede end to Kealey, Renton & Associates es general provisions and appkowe we"orowlons as shown an the ravens side. Certificate of Insurance PermitApproved: OF LODI �• Comp.Gen.Policy No. RP06645233 Exp.__..LLIL93 By Automotive Policy No. Exp, Referred to _ Curt Ji!ran 333-5835 Date Public Above Ground Date Inspected Date Public Underground Completed Date XX private,fobemirwir ed orrehmafedbyowneresngubea Reviewed Date Other PERMIT NO " i EnomWT PWD-=(Rev.fS/g7t white•hnpsctor Yellow-F4 ft*-Pa P tee