2316NOTE
With proper validation
this form constitutes an
encroachment permit CITY OF LA QUINTA
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
Subdivision Improvement Permit — Class I I I
DATE: 3-7-95 Minor Improvement Permit Class IV
LOCATION'OF CONSTRUCTION Avenida Rubio Between Durango & Sonora
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install. 101t of 2" Med Sketch (attach construction plans if appropriate)
pressure gas main
DESCRIPTION OF CONSTRUCTION Trenc in in earth. only
See attached conditions
DIMENSION OF INSTALLATION OR REMOVAL See attached drawings
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3-8-95
APPROXIMATE TIME OF COMPLETION
4-15-95
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration 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 re3ylt of this work.
Signature of Applicant or Agent
Southern California Gas Co. Y. 3 03 Redlands, CA 92373 (909) 335-7764
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 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
Received by
0
$ -0-
Date
PERMIT NO
2316
PERMIT VALIDATION
2316
DATE APPROVED 3-7-95
EXPIRATION DATE 4-15-95
DATESUE' f1 3-7-95
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
54145-034.
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA CITY OF LA PERMIT QII:T."
encroachment permit APPLICATION FOR �21, Q
PUBLIC WO KS CONSTRUCTION (E CROACHAA 6 I�%�
PUB LAIC ova ru;S
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
7 ` -
DATE: March 6, 1995
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
AVENIDA RUBIO N/CALLE SONORA
(Street ad ' or Description of Location)
1.
`�� `off i7 ZU Sketch (attach construction plans if
PURPOSE OF CONSTRUCTION appropriate)
DESCRI ION OF CONSTRUCTION 2121"Ii l -I L "t
DIMENSION OF INSTALLATION OR REMOVAL
To install 101' of 2".medium pressure
plastic gas main 7' W/EPL of Avenida
Rubio, beginning 250' N/NPL of Calle
Sonora, continuing north.
SIZE OF EXCAVATION, IF NEEDED SEE SKETCH CUT EARTH
THOMAS BROS PG 224 C1
APPROXIMATE TIME WHEN WORK WILL BEGIN 3 95
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Induding removal of all obstruction, materials, and debris, backfilling, oom-
pection and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and saw the City, its authorized agents, officers, representatives and a nployass, harmless from and against any and all
penalties, liabilities or loss resulting from damn or court action and arising out of any accident, low or damage to persons or property
happenlne or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twentyfour (241 hours in advance of that whenwont will be started.
Comply widh all applicable City Ordinances, the tarns and conditions of the permitland MI ru and regulations of the City of
Le Ouinte and to f»y for any additim d r"Mscwnant neo V 06ter refult of this -
Ashle
- - _ Sip"" WAVXiGantorAgent PER MF COORDINATOR
•S. p (71 4) -1764 Jk_
Nanta of Applicant (pies prints ; Business Address Telephone No. J j
Name of Contractor and Job Foremr► - . Busimet Address 'Telephone Nm
Contractor's License No. : , City Business License No. .
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit -Class 111
Public improvements: 3% of estimated construction costs ,
Private improvements: 3% of estimated construction costs
Minor Improvement Permit - Chis IV: See attached schedule
Inspection Fee t
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.—�
Received by Date
Recorded by
PERMIT VALIDATION _
PERMIT NO. *7
DATE APPROVED 3!/7-9
EXPIRATION DATE -
DATE ISSUED 3_ 7-2g
By ---
Administative Authority
TELEPHONE: (619)564-2246
' "he 10110 na aione►al aro ,pater Ore.visions are artnenso to aro me" t Dart at
Permit NO.
GENERAL PROVISIONS
"he folloanno snail always away.
ENCROACHMENT ON PRIVATE PROPERTY 'his oermn autnorfzes work tote accomolisneo woman City of
ONLY. Whenever construction extends whnin onvate crooenv. it snail be ane re
secure bermissfon from aouhin Lo his co frac o war
9 prpoern owners. Such autnorizataon must be seceueauiry ane oe mlrte06r1me encs to starting vwR tr
TRACKLAYING CONSTRUCTION EQUIPMENT: Clastsp trscktawnp cpnstrtrRton ecutecmv :neo n
OareD surface unless tmeo wnn smoom-tecoo street naps. All mechanical Dutra
a as Dernfdtep to coerms on em
:no O,vno curing excavations. Rubner-tVed edutpment Onfy snail be Used gnerasnail DafattedWitnrUbberati'eR
onement Is scarrsd, 30alla0. or broken curing the term of this contract or It the oa emecittili is is magna in antes existac
that tness corfaOns of rasa be resuRacep over tnnfr entire OaVao areal. If the ekitiinr
oevemsnt s manna. City of La Quina snail reaust
surtanng plea aoorbonats seal coat as itfeeffaad some. wino. Aesurtennq Snell consist of one
coat of two Incnee 12"1 of A.0
PROTECTION OF TRAFFIC: All excavations and work areas snail bsoroperiy lagntac and tsarrreadea
Engineer or La Quanta Citv Public Wants insoectors. Suitable detours and detour signs spall be clacad and
at the prolsa. The Ci as deemed nOcOmery by inn Gr
N snail be notated 24 Mrs. In advance at
any
traffic detours or dalinennons. rruinrauseptor the ouratioc
CARE OF DRAINAGE STRUCTURES: Any drainade structure including
concrete structures anccuntereo during excavation wnfcn neceaarptecorrugateo metal oeos. concrete
nepess an to remove Or movN snau be ►ealacgo in kind. In The *,naSteeculvert enc
nut einstain Onnaga structures. City of La Quanta snail be nmihed
Drainage structures and open drains snail be knot free of debr,a at all tames for eve►Rf is wain
onor to commengaate1tt of toes war:
RIGHT OF WAY proper drainage,
CLEANUP: Any surpws material resulting from excavation and backtdl operauons snau De remo
W,Y. All Oivgp Surtica3 snau be broomea aeon of earth and ether Oblectlonabls mater,, la,mmeplataly sitar Oaov el) a
Existing gutter fine and dram yea from tin acti o
age nitches snarl be repaacea to chair original slanoato or better. All •
prior to caving. Water tanker shall lis used. as r hatomoatroon
Oqu,rep. to sonnkle the excess mat"I snail be remawsy
Immediately sitar Oaadill. )p0 sale so kMp deem dust Cpflartlons app snail De use,
OE -WATER OPERATIONS. If do-watenn o0erm,ons are re wren and
the resconsabluty or the oarmfttee tccntraaorl to control ton water aatof as are tcrceng wetar on City df La Quints roads. it shall be
pro»de offstreet oamends* wn
CLOSING STREETS: No sues[ sf/a11 be elosea. A minimum of one she of traffic snail Oa maintain- at all tlm.e to
^ �aeary
sopa for the attaining pappap�y owners elle emergeaKmum a t ontes- In the Of traevent ics naiby the arm
am,engin Of tame. OertProo snap contact nn office to twwa rootto
cousin ins naeessa p meetnatnernuRttoaeemaeetfo
ry Permission.
SPECIAL PROVISIONS
The Ioltw,ng sn311 apply ONLY when Indicated:
R1 NOTIFICATION: Permfttee snail notify the City st-777 70 75
R2 CASH DEPOSITS OR BONDS: A cash bona or an a at loam se hours In advance of starting canetrtaetion.
shall lis turnlsnep in inn Hams of City of La O�OYep surety bond in an amount of not leas tnan s
roads and survey monuments. This Oona shall be eonts to �inuoua er all unto involved in fns reatoribon of the v,
posted ardor to commencement at any work an this by the Ci ales ha Quints
Project. City Engineer. T1ila bore must o,
UntmCLEARANCE. ISubs:ructureatprior toMaking
byOermh, ins pemfineesnail contact all concern
edair ;r ationwitnintheCityotlaOumtanghtpf
Damage to existin onrues rotative to the loco on at enwng�a�t r eo
g iubatrtJRUres resutteng from Oper,tiOnf aonauasd upper th4 perms shat) be the sole
itf fns oermmee. ubarucn+rea.
R4 UTILITY CLEARANCE: (Surface structures, No
work snail be done under infs cwmft until all utilities are aear of the
PtOposed work site. The oermmee snail notify ell concerned utility companies of the oracosm wom
R5 PAVEMENT WIDENING. Area between the
surtaceowrth Df000"a cpnersts gutter line and the existing road pave
+nehssafA.0 pavingplacopon merit snail be
having an •'R'veluPof hat less than inches at class
and Soecnications.andlnccntcrmancewirnCirvat ague ;oigregateaubbssecaurse
Ordtnancs a4g1, mprpwmentStandards
a) PARKWAY GRADING: Area between ins property line and too of the procosea concrete cum shall be n
1/4 inch to one toot I1 j.
g pbtoasiooeot
GRADES & STAKES. City of La Quanta snail establish graces and stakes for ins proposed concrete
caro and pu
construction.
tter 0R8 GRADE CHECKING: City otLaQuints snail eheagraces uoonreeerotototsnandof+ot,leend/orgnoea,senaptianedpy
a licensed engineer.
R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter 1
removed. Curb and/or turn and gutter snail be saw tut prior to removftiatlenall be
removal. fowl curb, matching concrete
gamer and
concrete onveway approaa� snail be constructed in conformance warn City of La Quints Standard #207,
R10 DRIVEWAYS. A.C.: Driveways snail be constructed as not to alter existing drainage pattern. Surfacing ovrv1een ins
PfOcOnv lane and the ensTing roan caving snail be 2• I /2 intoes of A. C. caving placed on 1
aggregate case. Driveway construction snail conform to artacned drawinb. _"I of ctaas_�
R 11 CULVERTS..:
mcnes oefow and in acne wa nria
meter I
culvert snail beinstalleo
neexisting flow tine. Culvert Installation snail conform to ins etuscneu browing,
waintheinvertaooroximatefvf. ;Z
12) SIGHT CLEARANCE. Signt clearance of 600 feet In either direlmon snail be assured and maintafnso.
R13 SOIL STERILIZER: The area to be sunscea snau be treated won soil ster,i,zar. Rate of aooilcation snap comply v nfn the
manutacturers sp'tetticMlons.
COORDINATE WORK: The proposed want shat, be subordinated to any operation which Ins Stats of California or
City of La Quints may conduct In this area aurin
GN of La Quints tares: to preclude delay or interference wPeriod on Staf this le orlCity at. tLassnail
Quintas o olseo owi[n the State or
R15 SURVEY MONUMENTS: Prior to exeav,teon or beginning of construction
ball survey monuments wnfth ens[ on to
elrtenine of all streets a croon to
involved snau be
be nauseep bye rty lines w
Ilcwtsm mall a In mmblmmv tied out so tnev may as reaalhennr....��.e
raw �w...�____. nit ae/Orfuryelipr of M� �.-
-,a nvt r 1.40NUMENTS. P -or to excavation or oeammrro er Construction, an survey monumenrs snail be 1„30u[ ovI
]t V Uuints ano sWUOIe Cayman, or Guarantee o, aayinent snail OI meas as reimDufsemem ipr gliwall= iiivOnrs
R17 � f1VEMENT CUTTING. Pavemem will tie meaunieaaay oat to a atraigm magi error to excavation. Matted of Otiwmem
06 useInG snail lin valeapprand to u tt trio f civfice Or Ina City Engineer. (Ungar n0 circumstance! snail .Mi"
oe used to excavate ono, to corona or oavemerttt;cayahoh memorial snail be OIaClO In sig^ a
tacintate the aenerat now or traffic. Prior to final a Exc 0 excavating eaWomest
Oerations. anv aamaoe to Cavememy stri daaldn as to it as
:orreneo. agnt sous snarl pe
R18 24VEMENT CUTTING. Pavement small be saw cut prior to removal Prior to final paying operations.
�^) pavement straight edge snail be correcteo.
C UMITOF EXCAVATIONS: Excavations snail be limited to 1. anv damage tc
begin. All excavations snail be orcoerrv, earricaded With lldntts pvlernegnte on -eesenos and not aaVSpacKror the oroteRlon of
Operations mus:
trench Colors
Instravennspupae.theCoen Worxsriodeceinspector snagdeterminemesui[aogirvorexeavaudnoarncamOfthearnease.No
exeavatlbh snail remain oxen ter a Ceflgp exceeding frvera a days, s a7tWvallon scall be naoae Umle
material is actually on Ina worK site.
ss fns construction.
(::R�D 8ACKFiLLMATERIAL Baattlll shall Coffee of prusn. rootsor otnerorganlc substance oetrlmema....a Use for ourooses
Of producing an scocustaly consolidated Cocktail. Any material
wnirn ins City Of La Quanta deems unsuitable (spongy or
saturated materials wnicn is encountered during excavation snarl not be used for oacktill. but snail be supplemented or
FOCIS OG oil an approved sand or gravel.
R21 BACKFILL SAND: Batxtdl Shelf be approved trans^-mai sand or equivalent and snail be placed in lifts of
rinan
three root 13.1 and vibrated using vtbrmantoer or eounaaem
rise a relative compaeuon of 95 percent snail be aaaineo wain nrthe -%:rL turat section Of the roacv gfeutan anv
t. Alternate methods may as strnted. but In anv
BACKFILL PLACEMENT: Bacadall snail be applied in lavers of not more than 50 percent of the total a wo at the erenen
before tloomng at a maximum of fave-rant 151 lifts wnwe trenenes areot ekeeaane aeptns. Care is to beam at th trent toe
btidctlll material IS not sublecte0 to exwents aweif by flooding apofations. Backfill materiel shill be pltgp b that SAO
resumngcotnogatonsituOenot less then 90pertemoreowvalen[tothesurrounemaerials.ail a placsthegreater
Cafflpaction. Where dancing or flooding is used for a maximum seniemem. fro u di ages Will lin is natr
the water. Where lentng is used. the les shall be of sufficient length to reach the bottom of each *averetainr Supply snag be coratnuous. uctn0 to water
Yn one the water
COMPACTION TESTS: If so required bvthe Inspector. Cbmpaaton tests snail be made at I ntervals of not more than 1.000
feet ana a minimum atone 111 test on earn road. One 111 copv of each test snail be ad or to the City Engineer tar
approval and tde0ono,tomaking Permanent repairs. Compaction tests snail bemaaeasoutlinedm rigCIttEngin a the
Standard Specifications, Division at Highways. State of California. dated January 1973
R24 COMPACTION TESTS If SO required by the InspgetCf. Canlpgctton testa snag be maae for each cross)
One 111 copy or earn test snail be forwarded to the City Engineer tar gppfOVtl and filed
prior to malting Or teftnats fine.
CompgatontestssntleD•maaegsoutlinedlnSemonti.101oftheStangtifgSpeeaieatlons.Oiyia �otM'annnreoalfa.
Of California. dated January 1973- apflrieys. State
R25 TEMPORARY PAVEMENT REPAIRS: After eompietton of backfill and comoaaton operations, a tefttppr.ry paten
consisting of 2 intxtea at SC 800 snail be placed on a prepared supgrade. The SC -800 temporary paying Shall be Placed
after a maximum at 3.000 linear feet of trench has Caen exava[ad and pacttfill aperattons compterea. put in all be P aced
inn pincement of the temporary pavement exceed a five (5) adv limit.
R28 PERMANENT PAVEMENT REPAIR: After backfill and cpmoaetton apmations nava Coen completed. a temporery patch
Surfacing of two inenes 121 of SC 8cl shall os laced Immediatelir A ermanent atcn of
Surfacing p p p
9 Ptacea pre a �� inch class base snail be placed no later than -�� ~03 A. C.
temporary toga repair. days after Completion of
PAVEMENT coldMiPavingREPAIR- F.A.S.: Upon
be pia etion of baekflli anoeomOaction. a lemoorarvpatcn consisting Of two inches 12,
b cola mix paving ches 16 1 shall be placed Immeatately. A permanent paten>n three Inrnea (3� of A.C. surfacing snarl
lin avaad on sal: inentes (ti -1 concrete base as atrectea. but not lata, grain fifteen t 151 days aver '1 of Completion s rf crop n i;
pM SO Conation Case sinal be of five•leat mis and shall conform to the City of La Quint& Road Impfavemsm Stanaaras
--� filo Sonuticgbona, Ordinance 8481.
C� FOG SEAL: fl fag sill coat consisting of an application
determined W the City Engineer. of asphaltic emulsion snag ps applied over all Douai drags as
cons
tin
R29 SEAL ARMOR COAT: a sate soar r to i suss of an application binder and screenings snag be aooued on all Catrn areas
where7.St near seat Boas sissad brier to ISSWface of this permit. Sege or armor coats snail be applied as specified In Section
37. Standard Specifications. State of California.
be ac[omalishad by a licensed cantraaor rengagedDivision of Highwava. Called January 1973. Work at pavement repair t
30 STREET on Of Permanent
Where street striping Is stial on streets In in@ s o oe a aOf vli elent f sucn striping snail be replaced upon
epair. a
COtnptetian of permanent repairs.
R31 TREE RELOCATION OR REMOVAL. Tree relocation within Ins City of La Quanta road right of way snail be accomolisneo
by a licensed. Canoed and insured tree service. and nanatedsately without mterterence or na:aro to Ina traveling puolic.
It Shag be the responsibdity of the permittee to maintain the tree In a vigorous growing conanaon at :is new location.
Trees to be removed snail be removea In sections which can be handled safely witnout Interference of fount to higrlwav
traffic. The entire width of the tree slump small be removed and disbOsewot so trial no debris remains In view of the
highwav rho slump note snail bebacktllleaandthorougniyccmoacteoasspecifiedinthefollowingParagraph.Whereat
becomes necessary to resmct traffic. the went shall be restricted to a mgxlmum of 500 }eat at any one time. Adequate
sighs flagmen and/or barricades shall be provided to protea the traveling public atall times
1Large,
ge Holts resulting from tree removal shall ba baattilled and compacted to not less tnan 90 percent or equivalent to the
Surrounding ground. whichever is the greater compaction as determined by the impact or field metnod Compaction
teats snarl comply with Section 6.3.01 of the Standard Specifications. Division of Highways. State of Califo►nas- dated
January 1973,
R32 TREE TRIMMING:
a. Only the necessary trimming snag be accomplisnea to Crdvlde clearance at the facility for one calendar veer
All broken or weak sections within the trimming snail be removed.
a Where Its necessary to restrict traffic.
signs.
Adequate signs, tris work shall be restricted to a maximum of 500 feet at anyone time.
(legman. anaior oarrieadaa snail be provided to protea the traveling public at all times.
C. If tree trunks are partially, Outside of the City of LA Quints ratio right of way. permmes snail make his own
arrongertltims watt adjoining Prdpagay owners for consort to the trimming In addition to the author. 7tition provided
by this oarttin.
d. All tree trimming on EVERGREEN TREES. PALM TREES. and other ORNAMENTAL TREES shag be SCCMmpiaahea to
the Satisfamon of the City Public Works Inspeaar,
a. Abcmane n.mr.........�.__ ___... _
SPECIAL CONDITIONS --PERMIT NO. 2316
--- THE GAS CO. ---
r
In addition to the standard permit conditions, the following shall apply:
1. All work shall be performed in accordance with the latest edition of the Standard Specifications
For Public Works Construction.
2. Permittee shall be responsible for providing continuous dust and erosion control.
3. Streets shall be kept clean. They shall be completely cleaned at the end of each working day
and more frequently if required.
4. Contractor - shall comply with the local noise ordinance. Operation, .and maintenance of
equipment within one half mile of -human occupancy shall- be performed only during the
following time periods:
October 1st to April 30: Monday -Friday 7:00 a.m. to 5:30p.m.
Saturday 8:00 a.m. to 5:00p. m.
May 1st to September 30: Monday -Friday 6:00 a.m. to 7:00p. m.
Saturday 8:00 a.m. to 5:00p.m.
Work shall be prohibited on legal holidays including Sundays.
5. Permittee/contractor shall assume responsibility for repair of any pavement damage to any public
or private street and for any damage to other City streets or facilities as a result of work
performed under this permit.
6. Advance warning signs and traffic control shall be installed and maintained in accordance with
Cal Trans Standards or the Work Area Traffic Control Handbook (WATCH Manual). It shall
be the permittee's responsibility to detour and barricade this site.
7. Street closures shall not be permitted. A minimum of one travel lane on paved surface shall be
maintained with flagmen at all times.
8. Prior to excavating, the permittee shall contact Underground Service Alert at 1(800) 422-4133.
9. Should additional work, materials, or modifications of the work be required in order to meet city
standards, safety requirements,, signage requirements, or to fit actual field conditions, the work
shall be performed by the permittee as directed by and to the satisfaction of the City Engineer
at no cost to the City of La Quinta.
Special Conditions - Permit No. 2316 Page 1 of 2
SPECIAL CONDITIONS ---PERMIT NO. 2316
continued
10. All work shall be coordinated with the City's contractor and others working within the area as
directed by and to the satisfaction of the City Engineer.
11. All backfill and subgrade soil shall be compacted to 90% relative dry density, all backfill soil
within the top 2' of finish pavement surface shall be compacted to 95% relative dry density, all
base material shall be compacted to 95% relative drydensity.
12. All excavations at or near the travel way shall be backfilled and paved at the end of every work
day as directed by and to the satisfaction of the City Engineer for the protection of the traveling
public.
13. All landscaping, irrigation, decorative rock, decorative concrete, lighting etc. shallbe replaced
to its original condition.
14. Access and egress to all local properties shall be maintained at all times.
15.' Permanent pavement replacementsection shall be one inch greater than existing.
16. If the work is to be performed by forces other than that of the utility company the contracting
company shall' be. required to apply for an additional encroachment permit 'and pay the
appropriate fee.
Special Conditions - Permit No. 2316 Page 2 of 2
Eo
I PLAN FILE NO.
BASE SKETCH I.o..TR.SKETC. OM PL. SKETCH
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Yes ❑
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(/\J
INSTALL MAIN WITH AT LEAST
'
Yes El
No 0
C.p. i :.P"
DATE MOVED DATE MOVED DATE OF
CY. Reviewed By;
RETIREMENT
/TY OF
RiAmW By-
ON JOB OFF JOB OPER._
COUNTY
�A Qu -N-11-
rA
SalvaeA
' .. -
TOTAL FEET INST'D.
�""
//�%/
(��• j�yJ
FEET RETIRED
I
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INSTALL MAIN WITH AT LEAST
'
"COVER BELOW v `�"
'-��' TOTAL
PERMIT ISSUED BY
PERMIT NO.
DATE MOVED DATE MOVED DATE OF
/U�;/��
RETIREMENT
/TY OF
ON JOB OFF JOB OPER._
COUNTY
_
CREW FOREMAN
DISTRICT G�T
REASON
COMPANY
'
'
TRACT ..
PLANNED BY
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COMPANY FACILITY:
SO. CAL. P.L.S. ❑
•
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NO.
ATLAS "%/�/� •/// -
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YEAR G.P.
INSTALLED
/ \ /
STAKING REO'D. ❑•
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REVIEWED BY
NO .t v
OR OVER ❑
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ORG. �/]
CATHODICALY
- __ YES ❑ NO
OPER. LEDs
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MICTRIC'T CIIPFRVIS0R
NO STAKES NEEDED
_
W.O.
CODE