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• City of Lodi Encroachment Permit <br /> Public Works Department Application (Non.-Construction) <br /> 1. Mame: Stericycle Environmental Solutions <br /> 2. Business Address: 11855 White Rock Rd, Rancho Cordova.CA 95742 <br /> 3. Phone: 916-351-0980 Work Phone: 916-351-0980 <br /> 4. Describe Special Event: <br /> (List structures placed on street and sidewalk.)__I. cjq,,%C114#k IWAgta rs waste callectlon event 19r residents _ <br /> of San Joaquin County A-frame situs indicating event will be placed at entrance of the site. <br /> Provide simple sketch locating structures within street closure. Structures located within street <br /> intersections are prohibited. <br /> 5. Identify Street(s)to be Closed, NiA <br /> 6. Identify the street closure limits to nearest street intersection: NIA <br /> 7. Date: 4/7/2018 Closure Times: ! u )pm <br /> (Be sure to allow and include time for"set-up"and"clean-up".) <br /> 8. Additional Information: <br /> Street closure shall comply with the"Street Closure Provisions". Insurance coverage is <br /> required. Proof of Homewowner's Policy shall be submitted. <br /> The undersigned agrees to indemnify and save the City of Lodi free and harmless from any liability in <br /> accordance with the provisions of Lodi Municipal Code (LMC)Sec. 12.04.040. Permittee is specifically <br /> aware of LMC Sec. 12.04 thereof relating to encroachments. The undersigned agrees and understands that <br /> a permit can be denied or voided in accordance with City of Lodi rules and regulations subject to inspection <br /> and approval. Permit application re. ,are rr„Fll il: Int <br /> DATE 2/22/2018 SIGNED ' ' <br /> OFFICE USE ONLY PERMIT STATUS: <br /> FEE: <br /> PERMIT N().20180810 ❑PEND!NG ❑FINAL Minimum amount(Balance to be collected at permit issuance) <br /> DATE&TIME RECEIVED ❑DENIED/WITHDRAWN TOTAL FEE: <br /> EncroachmentPermitAppNonConstdoc 3/8/2004 <br />