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City of Public Works Department <br /> _ 390 Towne Centre Drive,Lathrop CA,95330 <br /> Main(209)941-7430 Fax(209)941-7449 <br /> Permit No. 2019-20 <br /> ENCROACHMENT PERMIT <br /> Applicant Information: <br /> Applicant Name: Geosyntec Date: 4/24/2019 <br /> Mailing Address: 3043 Gold Canal Dr. Ste. 100 Applicant Phone No.: 916-637-8048 <br /> City, State, Zip: Rancho Cordova, CA 95670 <br /> Encroachment Location. Approx. 17550 Shideler Parkway <br /> Contractor Information: <br /> Contractor: Gress Drilling Construction/Project Manager: Mike Cramer <br /> Address: 950 Howe Road Contractor Phone No.: 925-313-5800 <br /> City, State, Zip: Martinez, CA 94553 License No.: C57-1044456 <br /> Bond Required: Yes:= No:Q Amount: Check/Bond: <br /> Release of Bond Approved By: Date: <br /> Final Inspection and Accepted By: Date: <br /> 24-Hour Contacts- Name & Phone No: <br /> Primary Contact: GarrettThomton Mobile No.: 208-301-8320 <br /> Secondary Contact: Nicole Gotberg Mobile No.: 916-798-7346 <br /> Permission Is Hereby Granted To: <br /> Drilling and Installation of a monitoring well in city owned property at 17550 Shideler Parkway behind Lathrop Industrial. <br /> Approximate Duration: 2 months,start:4122/19 <br /> Contractor must contact the Public Works Inspector at least 48 hours prior to start of construction. <br /> Final inspection is required prior to acceptance. Contact Robert McGinnis at (209) 992-0701. <br /> Submit accepted and signed permit to encroach mentpermitsVci.lath rop.ca.us to close out after final inspection- <br /> To perform work in the City's right-of-way,as shown on attached documentation to this permit,applicant is sub ect to all provisions on <br /> any part of this permit,and or attached hereto.The applicant's attention is directed to the genera provisions attached to this permit. <br /> This permit is to be strictly adhered to and no work other than specifically mentioned above is hereby authorized. <br /> This permit shall be void unless the work hereunder contemplated shall have been completed by: 10/25/2019 <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all conditions and requirements of this <br /> permit. <br /> PUBLIC WORKS DEPARTMENT: SIGNATURE OF APPLICANT: <br /> 44til <br /> Ste 1. Salvatore Date Name Date <br /> City Manager <br />