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;rn co ua wev u3 ui rli k;11r Ur t6URLUN FAX NO 209 838 8045 R 02 <br /> CITY OF ESCALON r,,f Permit No. <br /> STANDARD ENCROACHMENT PERMIT APPLICATION <br /> Permission is requested to encroach on City of Escalon right-of-way as follows: <br /> Name of Applicant: Geological _Technics Inc. — Phone No.: (209)_L38=6424 <br /> Address: 2711 River Road City: Modesto_ State: CA Lip: 95351 <br /> Location of proposed encroachment: <br /> Strvi:tNamv: Escalon Avenue Cross Street:Yoseinite Portion of ROW: <br /> Work to be performed by: _Own Forces X Contractor Est.Cost of Work: $15,000.00 <br /> Est.starting date: April 29 1999 Est.completion date: December 2,000 <br /> Description of proposed project(Attach 3 sets of plans,specs,tales,apps,etc..* See workplan attached <br /> (3) wells installation; trenching; piping cennection for filor testing; <br /> groundwater monitoring <br /> B MR Max_depth:4' Avg.depth: 44 ' Length. 100 Surf.acct.: 1 .5' <br /> Pipelines: Diann: 311 Type: PCV Product:va or Pressure/Voltage: vacuum <br /> Is any work being done on applicant's property? _,_,Yrs _No (If yes,briefly describe) <br /> Is a county/state/other agency involved?:•'X yes--NO <br /> If yes,have other permits and approvals been secured" x Yes —NO. <br /> The undersigned agrees that all work will be done in accordance with the City of Escalon cncroachrneut permit <br /> ordinance and supplemental conditions thereto as well as other applicable rules and regulations of the City of Escalotr <br /> and that all work done hereunder will be subject to inspection and approval. <br /> Authorized Sipature: 10 <br /> Title; (] Date: ' 9 <br /> Minor work chmsifications: FOR OFFICE USE ONLY <br /> — Survey — Fence --Mail box Application review fee S ;2,!5,— <br /> Flag. <br /> � <br /> Flag,banner, decoration Iaspection fee S 2 2, <br /> _ Parade, celebration TOW S�� <br /> Tetitporary signal <br /> Reviewed bv:� Fee collected by: <br /> Utility hookup- Gas Elec Water Serer Cable PEIVV IT CONDITIONS: <br /> Side�valkfutter Surety bond required? —Yrs Y No <br /> Amount: $ <br /> Rcsidenrial drive-way <br /> — Liability/property insurance r�:quired:� Yes —Na <br /> _ <br /> via inteoanccircconsrruction of dri.e or approach <br /> Ilona andror ins. cert. received? Yes No <br /> Other See Q�We �-k �a�. — St=d, Conditions �C Spec:til condstions:� <br /> Notify tktc following JS ,our.;prior to comm4ncim_ +nrk. ,'y seed ,7rrr.P opt, d c ss <br /> Public Works Superintt-ndenr......?tPC it issue y <br /> Building Inspector................... Terms: <br /> SEE RFVERSE SIDE -- <br />