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�QFt <br />,tCity of LodfPublic Works Departmenj <br />Permit Address 301 West Kettlernan Lane - Chevron <br />ENCROACHMENeO <br />PERMIT ,ti <br />Applicant's ,tl Name 6-1 Address <br />Gettler-Ryan Inc /Joe N; a)era (925) 3164 Gold Camp Drive, #240, Rancho Cordova, CA <br />Starting Hate 06/07/2000 Completion Date <br />Contractor Norm Porges <br />Date <br />06/05/2000 <br />Phone <br />(925) 551-7555 <br />Cellular <br />E(916) 631-1316 <br />06/23/2000 License No COL 9960 Phone <br />Address Cellular <br />Pursuant to the proxsions of the Lodi Municipal Code the undersigned applies for permission to excavate construct and/or cthervwse encroach cn Cdy Streel Right�of Way or Easement by <br />performing the following <br />NOTIFY USA (800) 227-2600 48 HOURS PRIOR TO ANY EXCAVATION <br />Work Description <br />The work con i t of on-site work per approved glans. Buildina Permit # B2038, <br />traffic c ntrol shall be gera roved submitted plans <br />installation of SS Dipe shall be prior to proposed off-site improvements, backfill <br />finish in sidewalk area shall be 2" AC finish bore beneath curb and gutter at <br />curb return match existing L grade, sidewalk to bg closed during installation <br />"Sidewalk Closed" signs re uired at nearest crosswalks, <br />Abandonment of 4�'SS shall be oer the approved attached correspondence and <br />comm_ertce_no later than 60 days after the approval of the Regional Water <br />Quality Control Board Applicant will grovide City with a copy of RWQCB <br />• approval, <br />Proof of USAlert membership required (Ticket #0145245) Insurance certificate_ <br />n w 1 to, be provided prior to expiration date Expiration of policy will void this <br />j2pri-nit. <br />(Sketch) <br />Permit void if work not Started within 6 months of permit date <br />7 Licensed Contractor required for this work <br />7 Certificate of insurance in the owner's name which names the "City of Lodi its elected and appointed Boards, Commissions, Officers <br />Agents and Employees' as an Additional Named Insured is required for Comprehensive General Aggregate In the amount of $1 000 000 per <br />occurrence and Automobile Liability Insurance in the amount of S1 000 000 combined single limit <br />The undersigned does hereby agree to Indemnify and save the Cay of Lod, free and harmless from any lability in accordance with the provisions of Sec 12 04 040 of the Lodi Mu0100211 Code <br />Pernuitee is specifically aware of Sec 12 04 290 thereof relating to she relocation or removal of said encroachment it future construclion requires such relocation <br />11 the work for which this encroachment pemnt has been issued has net been completed by _i6/2312000 the City of Lod, shall have the right to complete the work and to file a Cause of <br />Action to recoup the C y's expect s m omptelmg the work and fou all other cosu and fees in accordance "In I prrnns+on t 12 D4 12D of the Lodi Mun,cinal Code <br />DateSigned( <br />i <br />Required Improvement Security <br />Certification of Insurance <br />Arthur J Gallagher &r Co <br />Comp Gen Policy No PECO001987 Exp <br />Automotive Policy No PPP043160802 <br />f� <br />Other Policy <br />Referred to <br />Inspected <br />Completed <br />Reviewed <br />Tom Hathaway 333-67731-, <br />Exp <br />Exp <br />Date <br />Date <br />Date <br />Date <br />This permit is granted subject to all provisions of Chapter 12 04 of the Lodi Municipal Code <br />and to all general provisions and appticable speGal prowsions as show on the attached sheet <br />Permit Approved C17 OF LODI <br />By <br />P IC <br />Above Ground Date <br />Public Underground <br />JPrivatefobema+nfamedorrebcafedbyowner asrepufred <br />[j other Permit No. 20103 <br />Fee 241 00 <br />F7 Inspector Copy r:1 File Copy 0 Permittee Copy PWD -002 (Rev "7) <br />