08650
j J
NOTE:{
With proper validation
-,this f6(m.66
nstitutes an
CITY, A:
encroachment permit. OF Lk QUINT
APPLICATION, FOR..,PER'MIT
PUBLIC 'WORKS CONSTRUCTION *(ENCROACHMENT),- -
For tfie,co'nstruction- of 'public" or private curbs, driveways, pavements; sidewalks,
parking 16ts, sewers, water mains,
and oiherlike public works Jm'p"rdver'ents in connection with' MINOR IMPROVEMENTS and APPROVED, SUBDIVISIONS
i i g 9 0 0
oct6b i!�Ub'di�is1i' n. Improvemen t 'Pe'r"m it — Cliss III
DATE:.4 Mir�or Irpprovernent Perm it Class'IV
LOCATION I N OF'CONSTRUCT16N Park'Avenue,
(Sireet.address'or De'scriptiori of Location)
,'t'o iristall new gas, main...
_,i'PURPOSE,QF-CONSTRUCTION. Sketch (attach construction 61aiis if appropriate)
;DESCRIPTION:OF CONSTRUCTION - in 3 rtSf
•__1a_s'ti1C medium 6ressure. cas main -13",E1L .of...
*Park-.Avia.. beginning '5&8'- S/SPL'of 50th' Av'e. proceeding South,
DIMENSION OF -INSTALLATION' OR REMOVAL
SEE'. SKETCH TGP 21ao, .4-5, and 6
cut and .jet 334_1-.,
SIZE. OF'EXCAVATIONJF,NEEDED='
APPROXIMATE TIME'WHENWORK.Wl LL- BEGIN 1:0/.10/90-
APPROXIMATE TIME.OF.COMPLETION 1/10/--91
ESTIMATED CONSTRUCTION . . COST $
(including removal of all'obsir6dti6n, ma-terid',,'a'rid'debris, backfilling, c'om-
.'
pacticin and, placing permanent resurfacingand/or replacing improvements)
In consideration of,the granting of •this permit, tKe applicant hereby ag'rees to:
Indemnify, -defend. and save the City, -its authorized agents, -officers, 'representatives and employees, harmless from and against any and all
penalties, 1jabilities 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. peimit 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.
Cc r�s and applicable i'ules�ahcl
Comply with ;11 'applicable, City. Crdinances;tthe'ter `conditions permit and all applica regulations of the City of
La Quinta and to pay for any additional replacement necessary as,'he'result of 'this 'work:
.°J:M.'Snyder Distribution' Supervisor'
Signature of Applicant br"Aglent
Southern California 6as.Co*- PO Box 3003 Redlands, CA 92373 714'335-7742
Name of Applicant (pleas6-print) Busin'6s's Address Tel6phbrie No.
Name of Contractor and Job Foreman 'Business Address Telephone No.
Cont r*actor,'s. License No. City Business License No.
Applicant's Insurance Company" Policy Number
FEES: Subdivision'Improvement Permit — Class I I I",
Public improvement's: -3% of estimated construction costs
Private improvements: 3% of estimated construction costs
-Minor Improvement Permit- Class IV: See attached schedull e - - .
- 08 .65
1 1- . I . I . 4 . .. . , N' 11 li?
0
,Inspection Fee $ ,PERMIT VALIDATION
'Pe' X:*
rmit. Fee, PERMIT NO. 0865:
Penalty 10/11/90i.
Cash. Deposit -Surety Bond DATE APPROVED
if required -3/31/91.-
EXPIRATION DATE
/1
TOTAL: $ 7 DATE'ISSUED 101/90
Receipt No.
By
Received by Date Administr6tive Authority
Recorded by, TELEPHONE: (619) 564-2246
rvii�y�,��-^^,Cr'�d-ySW-•�-�+v`«rei�..rulr%1^$?�""sria`:""i+-'+��tt�`F,ih.µi':.::.f: ii' S .s. -.b:..
a
i
+ 4v+.+etin ir+�+�e<.'#ir" �y°l�+z. ?!�'►'s�dx p°r� qa 'e: r. wo er e> r..r ww :41 w r: -w "— - — r — r .-.rr V�'�a�.d ow
t.
NOTE:
With proper validation
this form constitutes an •i,
CITY OF LA QUINTA
encroachment permit.
APPLICATION FOR PERMIT
PUBLIC WORKS, CONSTRUCTION '(ENCROACHMENT)
For " the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
October 11, .x.996 Subdivision Improvement Permit = Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Park Avenue
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION t0 Install rieW gas main Sketch (attach constructiondans if'appropriate)
p ppropriate)
DESCRIPTION OF CONSTRUCTION" + n net-ai i7c3 of 910
clastic medium: 1oressure aas main 13' E/WPL of
Park . AvP.. beahnnin'a 588' S/SPIE. of 50th Ade i proceeding south
DIMENSION OF INSTALLATION OR REMOVAL
SEE SKETCH TGP 21k, #--5 and 6'
cut and jet 334'
SIZE OF EXCAVATION, IFNEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/10/90
APPROXIMATE TIME,OF COMPLETION 1/10/91
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debrisi'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
La. Quinta and to pay for any additional 'replacement necessary as the result of ..this. work.
J.A. Snyder, Distribution Supervisor
Signature of Applicant. or Agent
'Southern California Gas Co PO Box 3003 Redlands, CA.9237.3 714 335-7742
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 III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs Q
` Minor Improvement Permit — Class IV: See attached schedule'`�� �?
�0_
Inspection. Fee $ ' PERMIT VALIDATION
Permit Fee PERMIT NO. 086.5
Penalty.: 10/11/90 .
Cash Deposit Surety Bond DATE APPROVED
if required EXPIRATION DATE 3/31 /91
TOTAL: $ -0— 10/11/90 .
DATE ISSUED.
Receipt No.
By—
Received by Date Administrative:Authority
Recorded by TELEPHONE: (619) 564-2246
7
The following`General and Special Provisions are attached to and made apart of Permit No. o01a=�
GENERAL PROVISIONS
The following shall always apply:
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta right of way
ONLY. Whenever construction extends within private property, it shall be the responsibility of the permittee (or his contractors)to
secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAYING-CONSTRUCTION EQUIPMENT: Cleated tracklaying construction equipment shall not be permitted to operate on any
paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect
the paving during excavations. Rubber -tired equipment only shall be used in backfill operations in paved areas. If the existing
pavement is scarred, spatted, or broken during the term of this contract, or if the pavement is marred, City of La Quinta shall request
that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C.
surfacing plus appropriate seal coat as specified above.
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City
Engineer or La Quinta City Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration
of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations.
CARE OF DRAINAGE STRUCTURES: Any drainage structure including corrugated metal pipe, concrete pipe, steel culvert and
concrete structures encountered during excavation which necessitate removal shall be replaced in kind..ln the event -it becomes
necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work.
Drainage structures and open drains shall be kept free of debris at all times for proper drainage.
RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of
way. All paved surfaces shall be broomed clean of earth and other objectionable materia,is immediately after backfill and compaction.
Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed
prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used
immediately after backfill.
DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing wateron City of La Quinta roads, it shall be
the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited
access for the adjoining property owners and emergency vehicles'In-the event it isfelt bythe permittee that he must close a streetfor
any length of time, permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The follwing shall apply ONLY when indicated:
®RINOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction.
R2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than $
shall be furnished in the name of City of La Quinta to cover all work involved in the restoration of the various La Quinta
roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must be
posted prior to commencement of any work on this project .
R3 TILITY CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quinta right of way authorized
Dy
permit, the permittee shall contact all concerned. utility companies relative to the location of existing substructures.
Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility
of the permittee.
R4a�TILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities are clear of the
roposed work site. The permittee shall notify all concerned utility companies of the proposed work.
R5 'PAVEMENT WIDENING: Area between'the proposed concrete gutter line and the existing road pavement shall be
surfaced with _ inches of A.C. paving placed on inches of class aggregate subbase course
having an "R"value of not less than and in conformance with City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R6 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of
1 /4 inch to one foot (1').
R7 GRADES & STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter
construction.
aR
GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and pFofile and/or grades as established by
a licensed engineer.
R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( feet) shait be
removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and
concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207.
R10 DRIVEWAYS, A.C.: Driveways shall be constructed as not to alter existing drainage.pattern. Surfacing between the
property line and the existing road paving shall be 2-1/2 inches of A.C. paving placed on ( ") of class
aggregate. base. Driveway construction shall conform to attached drawing.
R 1 1 CULVERTS: A inch diameter( ) culvert shall be installed with the invert approximately 1-.1 /2
inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing.
V1R1SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained.
SOIL STERILIZER: The area to.be surfaced shall be treated with soil sterilizer. Rate of application shall comply with the
manufacturer's specifications.
D-'14COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of.California or
ity of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or -
City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects.
URVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
centerline of all streets or property lines when involved shall be completely tied out so they may be readily and correctly
be replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete setof notes showing the
ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall
R16 SURVEY MONUMENTS: Pr excavation or beginning of construction, all ey monuments shall, be tiedout by City
of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all worn involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically cut to a straight edge prior to excavation. Method of pavement
cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment
be used to excavate prior to cutting of pavement). Excavation material shall be placed in such a position as to best
facilitate the general flow of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
corrected.
18 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected.
R19 LIMIT OF EXCAVATIONS: Excavations shall be limited to 1,000 lineal feet of open trench before backfill operations must
begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of
the traveling public. The Public Works inspector shall determine the suitability of excavation barricading in each case. No
excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction
/11�aterial is actually on the work site.
20 CKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
f producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitable (spongy or
saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or
replaced by an approved sand or gravel.
RZ1 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed in lifts of notgreaterthan
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any
case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
R22 ACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
before flooding or a maximum of five-foot (5') lifts where trenches are of excessive depths. Care is to be exercised that the
backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the
resulting compaction shall be not less than 90 percent or equivalent to the surrounding ground, whichever isthe greater
compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain
the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water
supply shall be continuous.
R23 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervals of not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the
/---standard Specifications, Division of Highways, State of California, dated January 1973.
R24 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
ne (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs.
Compaction tests shall be made asoutlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State
California, dated January 1973.
R L25R25 MPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
consisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temporary paving shall be placed
after a maximum of 3,000 lineal feet of trench has been excavated and backfill operations completed, but in no case shall
e placement of the temporar, p. iieer,aiii extard d iiia 1'6) day iimit.
R26 RMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
;Consisting of two inches (2") of SC -800 shall be placed immediately. A permanent patchgf inches A.C.
surfacing placed on a inch class base shall be placed no later than i- days after completion of
temporary road repair.
R27 PAVEMENT REPAIR: F.A.S.: Upon completion of backfill and compaction, a temporary patch consisting of two inches (2")
of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3") of A.C. surfacing shall
be placed on six inches (6") concrete base as directed, but not later than fifteen (15) days after completion of temporary
paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R28 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
R29 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas
where such seal coats existed prior to issuance of this permit. Seal or armor coats shall be applied as specified in Section
37, Standard Specifications, State of California, Division of Highways, dated January 1973. Work of pavement repair to
be accomplished by a licensed contractor engaged in the business of pavement repair.
R30 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public.
It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be removed in sections which can be handled safelywithout interference or hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified in thefollowing paragraph. Where it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at any one time. Adequate
signs, flagmen and/or barricades shall be provided to protect the traveling public at all times.
Large holes resulting from tree removal shall be backfilled and compacted to not less than 90 percent or equivalent to the
surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction
tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated
January 1973.
R32 TREE TRIMMING:
a. Only the necessary trimming shall be accomplished to provide clearance of the facility for one calendar year.
All broken or weak sections within the trimming shall be removed.
b. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at any one time.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. If tree trunks are partially outside of the City of -La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
-
+44°3•'•rcf`R(�Y•�.• �4x^' .i
ADDITION =4- ENCROACHMENT PERMIT11 0865 ----CONDITIONS
y •. 1,,
t e 4r� K{fir'-<.' eff .,�'�i:t t:a•�tr �: sy.'r'" A.Kce'
�R333�
shall be' protected in '
'SAur'vey'`monum
s or
' ���" c' 're=es`talilisiied p%irsuant 'to City' standards and the State. -of ` ••..
' g`. California Land Surveyor's Act..
R3.4
Work..shall'be'coordinated• with ,th__e.City of La+Quinta''s
-
interference with the'City of La •
forces to reclude dela i
p y
'
.,or ,
Quinta I it 'projects `
R35
shall com 1 'with "the .local: noise ordinance and • - ,
• Contractor�r P Y.'
' r
construction'operations.and maintenance.of equipment within.,..'
one-half mile of human occupancy shall - be performed" only
'during the time -.periods as follows: "' ♦ `: , t
•
October'lst to,April 30: Monday -Friday 7:0.0a.m.-5:30p.`m.
'Saturday ;-: ,' 8 60a.m. -5: 00p.m. 4
--May,lst to 'September 30: Monday --Friday. 6:00a:m.-7:00p.m.'.,
Saturday - 8:004 in
Work shall be prohibited anytime -on Sunday-and.Federal +.
holiday. `J
' ,R36
Traffic control" shall be'. as per Cal, Trans Traffic manual. '
,
Field adjustments in detouring'shall.be'accomplished as.,
t.
directed in order to adjust.to•,actual field conditions. It,-r
shall be the*,'contractor!s.rresponsibility to adequately
shall
'
barricade and detour this site; A.Traffic control plan.shall-
•
be submitted for approval by the City Engineer.
R37'
All excavation- at -or near the: -travel• way• shall be- backf_illed'
at `the end° of • the• work day,•; for the protection',of the '•r
traveling public.
' •R38
Street closures.shall-not be allowed'at any time: y '
R39 ..
A minimum. 'of, one travel• lane ,shall - be maintained . at all ..
`
times, with, f lagmen during workingt .hours, • . - .,,:
R40,
,
All work -to -be performed within 'the' existing..paved.-section'
,.
shall be„temporary paved and maintained by•the`Permittee,;:' '
permanent pavement shall be placed,no later than 15'days
after completion of the temporary;.road repair,. '
R41,
Ingress 'and.,egress 'for local properties shall bermainta'ined
.-at all times.' _
.' R42
Prior -'to `work starting,, Underground Service Alert, .`shall be
'
contacted .at 1-800-422-4133 and' an :"inquiry` number" shall be'. .
'
provided to -the City Public Works Inspector.
%k4r3
Pavement shall ,be sawcut prior to removal.
.
S ,
` s= Aad'itiona•1, Conditions -'"Encroachment Permit No. 0865.
Page
2 4
'.. R44 All backfill subgrade'soil shall be• compacted, to nothing
less than 90s�relative dr densit-within.,'.
y y, ,;all backfill.,soil
t the'top 2'. of finish pavement,surface,shall be compacted -to+"
less 'than 95% relative dry density, all base.
material shall'be compacted to'nothing less. than 95°s�='
relative dry.density. Of
• R ;
.R45 .• Replacement' pavement sections, JsYia11 be AC over . 4 j: Class.-, a
r ` I I 'aggregate base : t x.
t
R46 If .the 'work is to' be performed by forcesother than that of • L
-•. the utility company, the,,contracting:company will be
required to apply. for .an. additional encroachment,- permit :' E �:;• y "
x
and pay ,the appropriate •.fee ..
jr I
i! r �sY - �„ ry ' _ J J�tF '< -x '...w i+' .. .,' ;, •M rte. '
- r .. r , :.' e ., i .} �rs ! # • JY7 Jam' .;, ( , t
i
i
NOTE:
With proper validation
this font' constitutes an CITY OF LA QUINTA
encroachment permit -
APPLICATION FOR PERMIT
58440-085 PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction, of public or private curbs, driveways, pavements, sidewalks, perking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS anti APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class 111
DATE: SEPT. 28, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Park Ave.
48treet address or Description of Location)
PURPOSE OF CONSTRUCTION Tn i n e t n l 1 nPw crag mai n Sketch (attach constructionlans if appropriate)
ppropriate)
M
DESCRIPTION OF CONSTRUGTh$ To install 2 o p astic medium pressure gas main 13' E/WPL of
ar Ave, beginning o ve., proceeding south. SEE SKETCH TGP- 214,E-5 & 6
CUT AND JET 334'
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10-10-90
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
Ilncluding.removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvenienu)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and saw the City, its authorized agents, officer, 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, Ions 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 loaf twenty-four 1241 hour in advance of the time when work will be started.
�;rCompiy with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
i+'Qiih to and to pay for any additional npfaoelrant raOasaM V as tle tart q wo46
RM
J-. M: NYDER DiS�nt.. SUPERVISOR '
Amt
Applianes Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs ,
Private improvements: 3% of eadmeted construction casts -.
Minor Improvement Parmit — Class IV: See attached schedule
Inspection Fee i
Permit Fee }
Pwwty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Onto
Recorded by
,c•
PERMIT VALIDATION
PERMIT 40.
DATE APPROVED,
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619)584-2246
AJ0
T eorasTw. sa
_ 41 b1.214E5!(r IrJT GFG•
fV: (SHEET
WM'E it �
L
INSTALL MAIN WITH AT LEAST
y SO CA4
�"� COVER BELOW
TOTAL FEET RETIRED
IVE%SI CE
RETIREMENT
PERMIT 193VED er
PERMIT NO.
GATE MOVED DATE MOVED
DATE OI
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-
COUNTY
:..
IT OF LAQ
'. I...•.
ON JOB -.Off JOB
OFCR...
.
DISTRICT
REASON.. ..
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CREW FOREMAN
TRACT • -ALJ
COMPANY
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NO.
YEAR C.P.
ANND BY
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COMPANY PACILITY'
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