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2-21-1997 a_©4PH FROM P. 2 <br /> 0 • <br /> OF <br /> CITY OF LODI ENCROACHMENT <br /> PUBLIC WORKS DEPARTMENT <br /> r 221 W.PINE ST. 333-6705 PERMIT <br /> CALL BOX 3006 <br /> LODI, CALIFORNIA 95241.1910 <br /> P13rm;tAddress 230 NORTH CHURCH STREET - CAIN ELECTRICAL CO. (North side of Lockeford <br /> ._ ,_ ss--from--s�i-ter <br /> Applicant's Name <br /> (Owner/Contractor) Ativant-ad,,,G, virnnmonfAl Address 180-1 W_ March 113,--Ste A. Stnrkfnn <br /> / /�/�%� 956-026 <br /> Starting Date r ,[-��,...-Completion Date �/..2/ _License No. --.- - .---Phone 5207 <br /> Agent /gill Little <br /> �V(�)blkdQ�vlkD(St i t)5r Address Phone__ <br /> Pursuant to the provisions of the Lodi Municipal Code,the undersigned applies for ptrmission to excavate,construct,andlor otherwise enWoach on <br /> City Street Right-of-Way or EaSemenl by performing the f011ow4ng work: <br /> NOTIFY USA (800) 642-2444 48 HOURS PRIOR TO ANY EXCAVATION. <br /> The work consists of dri 11 i ng/i nstal 1 at on of test bores <br /> fslr purposes in attar ;�ec�l�Zrkplan within the public right- <br /> of-way. Backfill to be as stated in workplan with minimum <br /> 4" A-C. finish. Match existing grades. Traffic control <br /> p-er C.al Trans 1raffi-c_.C_rZrLtral Manual 199 <br /> Permits _fr :other related agencies reguif—d. Notify <br /> aP,d-ITVYTT�JC��sc•he /—I-+-spec-ter-6t+rt jurari-(333-6836) <br /> prior to cta t_z.f_titnrk_ prpyldP t�S;�t�sultS to City of Lodi , <br /> Public Works Dept. <br /> Permit void if work not started within 6 months of permit date. (Space For Sketch) <br /> E) Licensed Contractor required for this work. <br /> LX Certificate of insurance in the owner's name which names the City of Lodi as an Additional Named insured for Com- <br /> prehensive General and Automobile insurance in the amount of$1,000,000 combined single limit is required. <br /> The undersigned Coos hereby agree to indemnify and save the Coy Of Lodi free and harmless from any liability,in accordance with the provisions of Sec. <br /> 12.04.040 of the Lodi Municipal Code.Permittee is specifically aware of sec.12 04 290 thereof relating to the relocation or removal of said encroachment If <br /> future construction requires sur-h relocation <br /> It the work for which this encroacriment permit has been issued has not been completed by _ _ the City <br /> of Lodi shall have the right to comoltte the work,and to file a cause of Action to rpooup the City's expenses in completing the work and for all other Costs <br /> and fees in accordance with the provisions of Sec. 12.04.120 of 1pe Looi Municipal Code <br /> �IlliiiiiiDate-ahg ASigned . ~ _, <br /> FPmproverment Security 7n-3 permit is rmranted subject to all provisions of Chapter 1204 of the Lodi <br /> Municipal Code and to all General provisions and applicable speclal provi• <br /> A&S& cions as shown on the reverse side.of nsurance <br /> ,Policy No. RP0�664b223Exp._7,.j f9-7 Permit Approved: CITY OF LODIAutomotve Policy No. _ Exp. __ By. <br /> Referred to Curt Jura 333-6836 pate � <br /> E3 Public Above Ground Date_ ;c <br /> Inspected _ Date <br /> O Public Underground <br /> Completed_- Date--- ❑ Private, to be marnrained or relocated by owner as required. <br /> Reviewed Date U Other Permit No. _ ��' <br />