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OF oo' CITY OF -10 ®I <br /> ENCROACHMENT <br /> PUBLIC WORKS DEPARTMENT <br /> e4tr�oR�'`P 221 W. PIN EST. 333.6706 P E R M I-T <br /> CALL BOX 3006 <br /> LODI, CALIFORNIA 95241-1910 <br /> rA <br /> mit Address Vicinity 1420 S-„ Hutchir�es&. 1340 'S. Hutchins St. <br /> licant's Name BROWN .& CADDWELL M "P0 BOX 13 449 Sacramento; CA95813- <br /> ner/Contractor) ddeess <br /> 344rting Date Comple#ion Date License No. Phone (916)444-0123 <br /> nerLContractor Steve Misner Addre sPhone <br /> suant to the provisions of the Lodi Municipal Code,the undersigned applies for permission to excavate,construct,and/or otherwise encroach on <br /> City Street Right-of-Way or Easement.by performing the following work: <br /> NOTIFY-USA (800) 642-2444. 48 HOURS PRIOR TOANY NY EXCAVATION <br /> �R d 11"111in oii burin s ai3dA tti111�0 aonitori i <br /> The work consists of 4 g . <br /> wells in arearat reat` of.sidewalk; locations as shown on site <br /> plan. (Attached.). .No drilling or borings in si ewalk, if possible. ; <br /> Ba.kkfill per work plan: cement grout mixture Oth 3” asphalt <br /> r _ If in i sh <br /> Traffic control per Cal Trans Traffic Control 4q --Note RECEIVED.. <br /> ltdin No. 6,"Gerierd! Prov is 101s' public. ""Sidewalk - <br /> Closed" si nae and barricades re uired at work site an&at 0rest SEP 2 11994' <br /> coOsswal ks:: <br /> Brown <br /> A ' W6 'consent from ro ert owners -affected,° work to:,be done <br /> at' sites as shown on plan: h <br /> Permit void if work not started within 6 months of permit_ da e.: (Space For Sketch) - <br /> 0 -Licensed Contractor required for this work: <br /> M( 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 does hereby agree to Indemnify and save the City of Lodi free and armless from any liability,in accordance with the'prvvisions of-Sec. <br /> 12.04.040 of the Lodi Municipal Code.Permittee is specifically aware of Sec.12.04.29 thereof relating to the relocation or removal of said encroachment If <br /> future construction requires such relocation.. <br /> ff the work for which th€s'encroachment' ermit'has been Issued fins not beerrcompiet tl by' { L r- the City <br /> of Lodi shall have the right to complete the work,and to file a Cause of Action to rec up the City's expenses in completing the work and for all othercosts <br /> and fees'In�accorda/ncewiith the provisions of Sec.12.04.120 of the Lodi Municipal ode. l ��' ��'{� <br /> Date ( f f :. Signed lf� vlrOu^- Catdw�` <br /> Required'Improvement Security � This ermit is granted subject to all provlstons of.Chapter 12.04 of the'Lodi <br /> Inc. uni, ipaI-Code and to all general.provisions and;applicable special provi- <br /> Jard�ne`Ins`.'Brokers `San i`ratici 5CO3 Bions as shown on the reverse.stde <br /> Certificate of Insurance: <br /> Comp Gen: Policy No. dQ847 25 ,13-O Xp 3/26/95 Permit Approved:?CITY OF LODI r "° <br /> �r 3/26/95 „ <br /> Automotive Pol�ijy No C <br /> �� <br /> Referred to aJG 44 <br /> te :s w, '. /`-' <br /> L] Public Above Ground.. Date .-� <br /> Inspected Date '` p•" Public 0 dergroundrl <br /> Completed Date WX Private, to be maintained or relocated by owner as required. <br /> Reviewed Date Li Other Permit No. <br /> 5190 • 500 White-Inspector Yellow-File ink-Permittee - Abrahamson Printing - <br />