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OFFICE USE ONLY PERMIT NO. 20170267 DATE & TIME RECEIVED ODENIED/WITHDRAWN $139.00 FEE: Minimum amount (Balance to be collected at permit issuance) TOTAL FEE: PERMIT STATUS: OPENDING OFINAL Encroachment Permit Application (Construction) City of Lodi Public Works Department Permission is requested to encroach on the City of Lodi's Right of Way as follows: (Complete all items. Use NA, if not applicable. Application is not complete until all required attachments are included.) Permit Address or Street Name Corner of W Tokay and S School Street, and Corner of Church and Spruce Street Cross Street Approximately 100 feet to corner of S School, and approximately 20 feet to Spruce Street Applicant Langan Engineering and Environmental, 501 14th Street, Oakland CA 94612 510-874-7000 Name Address City State Zip Phone No. Contractor California Push Technologies Inc. 820 Aladdin Avenue, San Leandro CA. 94577 510-357-3677 Name Address 510-357-3677 650-346-1490 Office Phone No. City State Zip C-57 license 884827 Cellular Phone No. License No. Estimated Start Date 02/02/2017 Estimated Completion Date 02/03/2017 Estimated Cost in City Right-of-Way (Excluding material costs) $9,950 Work Description (Fully describe work within City's Right-of-Way, including any street or lane closures. Attach separate sheet if necessary. Attach complete plans, specifications, calculations, maps, etc., where applicable.): Advance two (2) CPT borings at the following locations — on Tokay Street (between Church and School Streets), and near the intersection of Spruce and School Streets. California Push Technologies Incorporated (CPT, Inc) will be retained to advance the CPT borings to depths of approximately 100 to 125 feet below ground surface (ft bgs) using a 30-ton truck rig. Please see attached workplan. Additional Information (Check one or more of the following): El Sidewalk Replacement/ Installation: Length Lineal feet Sidewalk Width feet (Excluding curb) Driveway Replacement/ Installation (Check one): Residental Width Lineal feet Commercial Width Lineal feet Gutter Type (Check one if applicable): D Square (15" gutter) U Vertical (24" gutter) Rolled 0 Driveway D Other Utility Work Excavation M Directional Boring 0 Other Max. Depth 125 feet Avg. Depth 125 feet Avg. Width Length Surface Type Asphalt Conduit: Type Diameter 1.75 inches Other (Describe): The undersigned agrees to indemnify and save the City of Lodi free and harmless from any liability in accordance with the provisions of Lodi Municipal Code (LMC) Sec, 12.04.040. Perrnittee is specifically aware of LMC Sec. 12.04.290 thereof relating to the relocation or removal of said encroachment if future construction requires such relocation. Permit void if work not started within 6 months of permit date. The undersigned agrees and understands that a permit can be denied or a bond required for non-payment of prior or present permit fees, that the work will be done in accordance with City of Lodi rules and regulations subject to inspection and approval. Permit application fees are non-refundable. If the work for which this permit has been issued has not been completed within 6 months of permit date, 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 all other costs and fees in accordance with the provisions of the Lodi Municipal Code Section 12.04.120. DATE 2/3/17 SIGNED EncroachmentPermitApp.doc 3/12/2004