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CITY OF RIPON ENGINEERING DEPARTMENT PERMIT NO.: 259 N.Wilma Avenue,Ripon,CA 95366 EXPIRATION DATE: Phone(209)59921081 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.ciW. fdpon,orgldty hallideoartmentsfengineering for submittal requirements. PROJECT INFORMATION . Site Address: 311 West Main Street, Ripon,CA 95366 • Is this Permit associated with any existing projectipermit?0 Yes ® No • If Yes, Project(Permit No. • Projected Start Date: ca-*,.22 . Projected Completion Date: g'g•2Z_ •Check all appropriate categories which describe the project: ❑ New Construction ❑ Maintenance or Repair Streets Public Utilities Other Utilities fampan 9 Curb and Gutter 7: Water Service(s) 0 Gas ❑ PG&E © Driveway Approach(es) ® Sewer Service(s) ❑ Electrical ❑ Wave Broadband R Sidewalk 9 Storm Drain Connection(s) ❑ Service Hookup(s) 0 Street Tree(s) Z: Street Light(s) ❑ Excavation/Trench Traffic Control 0 City Landscaping N Boring 0 Yes, Using Caltrans Standards Street Surfacing ❑ Overhead ❑ Traffic Control Plan Submitted M Asphalt Patching 0 Testing/Surveying ❑ Lane Closure(s) • Fully describe work within City Right-of-Way: Soil Vapor and Groundwater Site Investigation to assess possible PCE contamination from the former Ripon Cleaners. -Utility Locating and Video Survey of nearby sanitary sewer and utilities. --28 x 1.5"diameter Soil Vapor Probes with sample collection to-3-foot depths. -3 x 2"diameter Soil Borings with soil and groundwater sample collection to--25-35-foot depths. LICENSED CONTRACTOR INFORMATION • Company Name: APTIM Environmental & Infrastructur • E-mail: james.teo@aptim.com • Contact Person: James Teo • Phone No.: (650)862-3842 • Mailing Address: 4005 Port Chicago Highway • Contractor License No.: General 998883 HazC-21 1048756 •City/State/Zip: Concord, CA 94520 • Business License No.: 14996 APPLICANT INFORMATION/CERTIFICATION •Applicant Name: James Teo • E-mail: james.teo@aptim.com • Mailing Address: 4005 Port Chicago Highway • Phone No.: (650)862-3842 9.25=997-J�U� • City/State/Zip: Concord, CA 94520 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 adhered to as such. Applicant/Authorized Agent SIGNATURE: _ �+ Date: /_ a U a, APPROVAL(OFFICE USE ONLY) Permission is hereby granted to the applicant to do the described rk in pli nee with Chapter 12.12 of the City of Ripon Municipal Code. City of Ripon Authorized Agent SIGNATURE: Date: ' UPON AP ROVAL POST THIS PERMIT AT WORK SITE Contact the Engineering Dept. at 209-599-2108 at least 48 hours prior to construction 020'Encroachment PermiisiForms Versior