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City Of Public Works Department <br /> 390 Towne Centre Drive, Lathrop CA,95330 <br /> �= Main(209)941-7430 Fax(209)941-7449 <br /> Permit No. 18-39 <br /> ENCROACHMENT PERMIT <br /> Applicant Information: <br /> Applicant Name: Geosyntec Date: 11/5/2018 <br /> Mailing Address: 3043 Gold Canal Dr. Ste. 100 City: Rancho Cordova, CA Zip: <br /> Encroachment Location: Approximately 16353 McKinley Avenue <br /> Contractor information: <br /> Contractor: Yellow Jacket Drilling, Inc. Construction/Project Dean A.Coblish <br /> Manager: District Manager <br /> Address: 9460 Lucas Ranch Road City: Rancho Cucamomga, CA Zip: 91730-5743 <br /> Contractor Phone No.: Office:909.989.8563 License No.: C57-1034407 <br /> Cell: 909-544-1135 <br /> Bond Required: Yes No X Amount: Check/Bond: <br /> Release of Bond Approved By: Date: <br /> 24-Hour Contacts - Name & Phone No: <br /> Name: Garrett Thornton Phone No.: 208-301-8320 <br /> Name: Nicole Gotberg Phone 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 Avenue. <br /> Contractor must contact the Public Works Inspector at least 48 hours prior to start of construction. Final <br /> Inspection is required prior to acceptance.Contact Robert McGinnis at(209)992-0701. <br /> To perform work in the City's right of-way, as shown on attached documentation to this 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: 3/5/2019 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all conditions and requirements of this <br /> permit. <br /> PUBLIC WORKS DEPARTMENT: SIGNATURE OF APPLICANT: <br /> -- en J.Sa store Date Name -r Date <br /> City Manager rrjs},Wt%r�J`- I -i-,L--mv <br />