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CITY OF RIPON PERMIT NO.: 102 7.2- ENGINEERING DEPARTMENT 259 N.Wilma Avenue,Ripon,CA 95366 EXPIRATION DATE: Phone(209)599-2108/Fax(209)599-2685 EXTENSION DATE: Website:www.cityofripon.org ENCROACHMENT PERMIT APPLICATION Required for all activities in the Public Right-of-Way(ROW)or Public Easement Complete all items below. APPLICATION IS NOT COMPLETE UNTIL ALL REQUIRED SUBMITTALS ARE INCLUDED. Visit our website at www cltyofripon oro/ptv l�iWeoartments/engineerin for submittal requirements. PROJECT INFORMATION • Site Address: Intersection of 1st Street and South Stockton Ave, Ripon CA • Is this Permit associated with any existing project1permit9 D Yes ® No • If Yes.Project/Permit No. • Projected Start Date: 6/13/2022 • Projected Completion Date 12/31/2022 • Check all appropriate categories which describe the project: X New Construction f--� Maintenance or Repair Streets Public utilities Other Utilities Company ❑ Curb and Gutter D Water Service(s) ❑ Gas ❑ PG&E ❑ Driveway Approach(es) D Sewer Service(s) D Electrical O Wave Broadband ❑ Sidewalk D Storm Drain Connection(s) ❑ Service Hookup(s) ❑ Street Tree(s) El Street Light(s) ❑ Excavation/Trench Traffic Control ❑ City Landscaping ® Boring D Yes, Using Caltrans Standards ❑ Street Surfacing ❑ Overhead D Traffic Control Plan Submitted ❑Asphalt Patching ❑ Testing/Surveying ❑ Lane Closure(s) • Fully describe work within City Right-of-Way: Advance one boring (up to 16 feet deep)to install one soil vapor monitoring well and collect soil vapor samples. LICENSED CONTRACTOR INFORMATION • Company Name. Geocentric Drilling Inc • E-mail: mike@geocentricdrilling.com • Contact Person: Mike Cramer • Phone No.: (916) 304-2665 • Mailing Address: 1980 S. River Road, Suite E • Contractor License No.: 1073146 ✓ West Sacramento, CA 95691 • Business License No.. 1.3-101 • City/State/Zip: APPLICANT INFORMATION I CERTIFICATION • Applicant Name: Haley&Aldrich, Inc • E-mail: jgalvin@haleyaldrich.com • Mailing Address: 426 17th Street, Suite 700 • Phone No.: (510) 879-4579 • City/State/Zip: Oakland/CA/94612 The undersigned hereby requests the City to permit encroachment inion the City right-of-way as described above. It is understood that the encroachment,when constructed, shall be in accordance with the sketch attached and made a part hereof, and no work other than that specifically mentioned above.is hereby authorized. Undersigned agrees to be bound by the provisions of the ordinances,specifications and regulations of the City of Ripon,including but not limited to Section 12.12 of the City of Ripon Municipal Code, and all the terms, conditions and restrictions as general or special provisions on any part of this form,and/or attached hereto. Accepting this permit or starting work herein described shall constitute acceptance and agreement to all the conditions and requirements as set forth and will be adhered to as such. Ograey SWee by Jennifer GaMn Applicant/Authorized Agent SIGNATURE: Jennifer Galvin Dale,202205.17 172923-oro_ Date: •/ Z APPROVAL(OFFICE USE ONLY) Permission is hereby granted to the applicant to do the bed vrin corrinUfffice wi Chapter 12.12 of the City of Ripon Municipal Code. �I of Ripon Authorized Agent SIGNATURE: ` Date: ~v� UPON APPROVAL PO HIS PERMIT AT WORK SITE Contact the Engineering Dept. at 209-599-2108 at least 48 hours prior to construction 1,120iEncroach nenr Permils�Forms Version 202/.05