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NOTE:. REFERENCE GTE W.0 1174=I :.
With proper valjda�66' CITY OF RANCHO MIRA at
this form constitutes anu
APPLICATION NOV
• encroachment permit '
If �99Q 3
------- FOR PERMIT PUBLIC, WORK
" -
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
- For the construction of public orsprivate:curbs, driveways, pavements, -sidewalks, parking lots, sewers,.water mains �...
and other like:public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
- - - Subdivision Improvement Permit —'Class:[ I I 1 ^1
DATE: NOVEMBER .14, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Washi ngton' a.nd Avenue 50 .
(Street address or Description of Location)
Sketch (attach construction plans if appropriate)
PURPOSEOFCONSTRUCTION .to--ab'andon'rnanhole
DESCRIPTION OF CONSTRUCTION remove m. h . lid and ring See attached drawing
DIMENSION OF INSTALLATION OR REMOVAL N/A
SIZE OF EXCAVATION, IF NEEDED back fill manhole
10'6"x5'x6' and' -'re' -new asphalt
APPROXIMATE TIME WHEN WORK WILL'BEGIN 3-1-911 -
APPROXIMATE TIME OF COMPLETION 8-30-91
ESTIMATED CONSTRUCTION COST $ 2;100.00
(Including removal of all obstruction, materials, and debris, backfilling, com
paction and placing permanent resurfacing and/or replacing improvements)
Inconsideration of the granting of this permit, the applicant hereby agrees to: `\
Indemnify, defend and save the City, its authorized agents, officers,. representatives and employees, harmless from and
against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or
damage to persons or property .happening or occurring as a proximate result of any work undertaken under the permit
granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work.will be started.
Comply.with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations
of the City of. Rancho Mirage, including the ,rules printed on the reverse of this permit,and to pay for any additional re-
placement necessary as the result of: this work.
J,
Sijnatu r(j A p icant or Agent
GTE CALIFORNIA`.INCORPORATED 83-793 Dr Carreon:Blvd; Indio, Ca 92201 619/342=0535
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
'Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit—Class II1"O 0271
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Inspection Fee
Permit.Fee
Penalty �.
Cash Deposit -
Surety Bond
if required
TOTAL-,..,.
Minor Improvement Permit —Class IV: See attached schedule
$
PERMIT VALIDATION '
PERMIT N0.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
BY
Receipt No. Administrative Authority
Received by Date - TELEPHONE (714) 324-4511
Recorded by
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