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City of Public Works Department <br /> 390 Towne Centre Drive <br /> �— Lathrop Ca,95330 <br /> Main (209)941-7430 <br /> Fax (209) 941-7449 <br /> Permit No. 2016-40 <br /> ENCROACHMENT PERMIT <br /> Applicant Information: <br /> Applicant Name: HvdroFocus, Inc. Date 9/13/16 <br /> Mailing address: 2827 Spafford Street City: Davis Zip: 95618 <br /> ✓ ✓ V, ✓ <br /> Encroachment Location: Rail Way/Barbara Terry/E. LouiseNillaee Ave <br /> Contractor Information: <br /> Contractor: Confluence Environmental, Inc. Construction Manager: <br /> Address: 3308 EI Camino Ave.. Suite 300#148 Contractor Phone No.: 916/760-7641 <br /> City: Sacramento Zip: 95821 License No.: 913194 <br /> Bond? Yes No X <br /> AMOUNT: CHECK/BOND#: Release of Bond Approved By: <br /> Two(2)24-HOUR CONTACTS - NAME & PHONE NO: <br /> Christine Lucero 818/606-2505 John Fio 530/219-4458 <br /> PERMISSION IS HEREBY GRANTED TO: <br /> Abandon (4)existing monitoring ivells located in street/bike nnth areas. This work will be nerfonned for the City of <br /> Lathrop's—CIP# WW10-15 <br /> CONTRACTOR MUST CONTACT PW INSPECTOR AT LEAST 24 HOURS PRIOR TO <br /> CONSTRUCTION AT(209) 992-0701. <br /> To do work in the City right of way as shown on attached application you are subject to all the provisions on any part of this form, <br /> and or attached hereto. <br /> Your attention is directed to the general provisions attached to this permit. This permit is to be strictly adhered to <br /> and no work other that specifically mentioned above is hereby authorized. <br /> This permit shall be void unless the work hereunder contemplated shall have been completed by: 12/13/16 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all conditions and requirements of <br /> this permit. <br /> Public Works Department: Signature of Applicant: <br /> Tim M lie 'rector <br />