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City of Public Works Department <br /> 390 Towne Centre Drive, Lathrop CA,95330 <br /> 6a� Main(209)941-7430 Fax(209)941-7449 <br /> Permit No. 2019-15 <br /> ENCROACHMENT PERMIT <br /> ApElicant Information: <br /> Applicant Name: Geosyntec Date: 3n5/2019 <br /> Mailing Address: 3043 Gold Canal Dr. Ste. 100 Applicant Phone No.: <br /> City, State, Zip: Rancho Cordova,A <br /> Encroachment Location: Approximately 16200 McKinley Ave. <br /> Contractor Information: <br /> Contractor: Gregg Drilling Construction/Project Manager: Garrett Thornton <br /> Address: 950 Howe Road Contractor Phone No.: 925-313-5800 <br /> City, State, Zip: Martinez,CA License No.: 1044456 <br /> Bond Required: Yes: 0 No:LL]Amount: Check/Bond: <br /> Release of Bond Approved By: Date: <br /> Final Inspection and Accepted By: Date: <br /> 24-Hour Contacts- Name & Phone No: <br /> Primary Contact: Garrett Thornton Mobile No.: 208-301-8320 <br /> Secondary Contact: Nicole Gotberg Mobile No.: 916-798-7346 <br /> Permission Is Hereby Granted To: <br /> Drilling and installation of a monitoring well in the city owned right-of-way west of McKinley Ave. <br /> Approximate Duration: 3 weeks <br /> Contractor must contact the Public Works Inspector at least 48 hours prior to start of construction. <br /> Final Inspection is required prior to acceptance. Contact Robert McGinnis at (209) 992-0701. <br /> Submit accepted and signed permit to encroachmentpermits ci.lathroo.ca.us to close out after final inspection. <br /> To perform work in the City's right-of-way,as showy on attached documentation to th-s permit,applicant is subject to all provisions on <br /> any part of this permit,and or attached hereto.The applicant's attention is directed to the general provisions attached to this permit, <br /> This permit is to be strictly adhered to and no work other than specifically mentioned above is hereby authorized. <br /> This permit shall be void unless the work hereunder contemplated shall have been completed by: 9/25/2019 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all cond tions and requirements of this <br /> permit. <br /> PUBLIC WORK5 DEPARTMENT: SIGNATURE OF APPLICANT: <br /> ephen J. Salvatore Date Name Date <br /> City Manager <br />