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Page 4 of <br />CITY OF COLTON <br />ENGINEERIG DEPARTMENT <br />ENCROACHMENT PERMIT APPLICATION <br />HOLD HARMLESS AGREEMENT <br />IN CONSIDERATION OF THE GRANTING OF THIS APPLICATION FOR AN ENCROACHMENT <br />PERMIT, THE APPLICANT HEREBY AGREES TO: <br />1. Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, <br />harmless from and against any and all penalties, liabilities or loss resulting from claims or court <br />action and arising out of any accident, loss or damage to persons or property happenings or <br />occurring as a proximate result of any work undertaken under the permit granted pursuant to this <br />application. <br />2. The property owner will need to remove/relocate encroachment installed or maintained under this <br />permit, within 30 days of written notice from the City, if determined by the City Engineer that the <br />effected Right -of -Way is needed for Public improvements <br />3. Notify the City Engineer in writing at least forty-eight (48) hours in advance of the time when work will <br />be started and upon completion of the work immediately notify the City Engineer in writing of such <br />completion. <br />4. Comply with the terms and conditions of the permit and all applicable rules and regulations of the <br />City of Colton and other public agencies having jurisdiction. <br />The applicant agrees to all of the above conditions. <br />PERMIT NUMBER <br />A.P.N. <br />ADDRESS <br />Sigfiature of Applicant <br />Z.1- to <br />Date <br />Said encroachment permit is hereby issued by the City Engineer, permit shall be valid from this <br />date forward for a period of <br />The above -noted <br />conditions shall remain in effect for the duration of said encroachment permit; failure to comply <br />with any and all of said conditions shall be cause and just grounds for the revocation of this <br />encroach meqpermit. <br />Amer Jakher, City Engineer <br />I Z -'3 w3 <br />Date <br />