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0373W.O.#53448-421 NOTE. Witi' proper validation this form constitutes an 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 • Subdivision Improvement Permit — Class I11 DATE: FebrLla�y .13, 1989 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Avenida Villa south of Calle Hidalgo-. (Street address or Description of Location) PURPOSE OF CONSTRUCTION To install, 120' of 2" plastSketch (attach construction play s if appropriate) medium pressure a' as main. 10''W/Enl of Villa. DESCRIPTION OFCONSTRUCTION. SEE SKETCH TGP 224 .n1 CUT—EARTH DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION 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 fhe'time when work will be started. . Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulationslof the City of La Quinta and to pay fog any additional replacement necessary as the result of this work. J.M. .13hyder, Distribution Supervisor Signature of Applicant or Agent 'SOUTHERN CALIFORNIA GAS CO. P.O. BOX2.200 Riverside, Ca. 92516 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 1.11 Public improvements: 3% of estimated construction costs • . • Private improvements: 3% of estimated construction costs N'00 0 Minor Improvement Permit — Class IV: See attached schedule ` Inspection Fee $ NA PERMIT VALIDATION' Permit Fee NA 373 1- •PERMIT NO. Penalty DATE APPROVED 2/13/89 Cash Deposit -Surety Bond if required EXPIRATION DATE 8/1/89 TOTAL:, $ —0— 2/13/89 • ,DATE ISSUED _ - Receipt No. B Y Received by Date Administrative Authority . Recorded by TELEPHONE: (619) 564-2246 W.0.#53448-421 :.NOTE: With proper validation this form constitutes an CITY OF LA OUINTA .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 February 7, 1989 Subdivision Improvement Permit -Class 111 DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION - Avenida Villa Got h of. Ca 1 1 P Aida 1 gn _ (Street address or Description of Location) PURPOSE OF CONSTRUCTION 'To install 120' of 2" elastic .DESCRIPTION OF CONSTRUCTION SEE SKETCH TGE 2:2401 DIMENSION OF INSTALLATION OR REMOVAL. SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans If appropriate) CUT -EARTH APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COSTS • (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 lou resulting from claims or court action and ahsing 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 124) 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 Le O,uinte and to pay for any additional replecament.raecgnry as theIt IF this•wo . V NYgR��04TR TRI�JT TON S1JPFRVT�GR__ Signature of Applicant or Agent SOUTHERN CALIFORNIA GAS CO. P_0_ Rox 2200 RivprcirlpsrA g9�fF Name of Applicant (please print) Business Address Telephone No. Norm of -Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Busiftess 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 Minor. !mprojament Parmit - Class IV: Sao atti;idwd iichaduie. Inspection Fee $ Permit Fee A% Penalty .Cash Deposit -Surety Bond if required TOTAL: W. $ -0 . Receipt No. Received by ate Recorded by' PERMIT VALIDATION PERMIT.NO. _5 Z -1 DATE APPROVED EXPIRATION DATE DATE ISSUED �- 4 By Administrative Authority TELEPHONE: 1619) 564-2246 W.O. #53448-421 ,A•. , NOTE: • `. . 4 " With proper validation •y ` 4 Q this form constitutes an s' 4 1 �,. encroachment permit � CITY, OF L A QU NTA; �• � � _ •--APPLICATION, FOR -PERMIT -;f` PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)�� '' �Sw4�`• OF 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 APPROVE_ D SUBDIVISIONS • ♦ • I + .. Februar '13 1989. Subdivision Improvement Permit— Class III . DATE: Y Minor. Improvement Permit Class IV' Xi LOCATION OF CONSTRUCTION, Avenida. Villa. south of Calle Hidalgo. (Street address or Description of Location) PURPOSE OF CONSTRUCTION. To install 120' 'of 2'.' ip 'as 19k6•%ch•(attach constructionlans if appropriate) ppropriate) medium pressure gas main, 10` W/Epl-of Villa. DESCRIPTION OF CONSTRUCTION SEE`SKETCH TGP 224 ,D1 CUT -EARTH ' 'DIMENSION OF INSTALLATION OR REMOVAL r SIZE OF EXCAVATIONJF NEEDED •• ti s APPROXIMATE TIME WHEN WORK WILL BEGIN t , APPROXIMATE TIME OF COMPLETION i 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:. • f" , Indemnify, defend andsave.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 wproximate 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 theJCity of La Quinta and to pay for, any additional `replacement necessary�as the result of this work. - J.M. .Snyder, • Distribution. Supervisor T • Signature of Applicant or Agent SOUTHERN CALIFORNIA GAS C0._ P.O. BOX2200• Riverside, Cad. 92516 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 - s.71 FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimatedconstruction costs Private improvements: 3% of estimated construction costs, " Minor Improvement Permit — Class IV: See attached schedule N • 3 1 3'. ,Inspection Fee $ NA PERMIT VALIDATION Permit Fee NA 373, ° s • PERMIT NO: Penalty/'8 Cash Deposit -Surety Bond DATE APPROVED '2/139 if required "; - EXPIRATION DATE 8/1/89 $ -0 x•2/13/89 TOTAL: DATE ISSUED 'Receipt No. B Received by " Date Y '• Administra'tive'Authority Recorded by TELEPHONE:(619) 564-2246 " The following General and Special Provisions are attached to and made a part. of Permit No. GENERAL PROVISIONS The following shall always apply: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta rightof 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, spalled, 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. In 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 rightof way. All paved surfaces shall be broomed clean of earth and other objectionable materials 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 water on 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 street for any length of time, permittee shall contact this office to obtain the necessary permission. SPECIAL PROVISIONS The follwing shall apply ONLY when indicated: R1 NOTIFICATION: 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 continuo.us until cancelled by the City Engineer. This bond must be posted prior to commencement of any work on this project . R3 UTILITY CLEARANCE: (Substructures) Priorto making anyexcavationwithin the CityofLaQuinta right ofwayauthorized by 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. R4 UTILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities are clear of the proposed 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. R8 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 shall 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. R11 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. R12 SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained. R SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall comply with the , manufacturer's specifications. R14 COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or City 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. R15 SURVEY 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 set of notes showing the ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall be notified upon completion of replacement of all survey monuments for proper project clearance. R16 SURVEY MONUMENTS: Pi _. _j excavation or beginning of construction, alp sur vey monuments shall be tied out by City of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all work 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. IR181 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to pavement straight edge shall be corrected. R191 LIMITOF EXCAVATIONS: Excavations shall be limitedto 1,000 lineal feet of opentrench before backf ill 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 /-� material is actually on the work site. ,R20 : BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes of producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitables on (p gyor 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. R21 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,) BACKFILL 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 is the 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. IR23 ) 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. 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. R25 TEMPORARY 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 the placement of the temporary pavement exceed a five (5) day limit. R26 1 PERMANENT 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 patch of inches A.C. surfacing placed on a inch class base shall be placed no later than days after completion of temporary road repair__5z�C- _7Q - S' 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. �1`1301 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 safely without 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 shal I 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. f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches (2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector. R33 R34 R35 R36 R37 R38. R39 R40 ADDITIONAL CONDITIONS s ENCROACHMENT PERMIT NO. 373 ' Survey monuments shall be protected in place or, re-established. pursuant to City standards and the State of California Land,Surveyor's Act.,. Contractor shall comply with the local noise ordinance and construction operations and maintenance'of equipment within _ one. half mile ,of human occupancy, shall be performed only during.the time periods as follows October 1st to April 30: Monday -Friday 7:00a.m.-5:30p.m.. Saturday 8:00a.m.-5:00p.m. May lst,to September.30: Monday -Friday 6:00a.m.-7:00p.m. Saturday 8:00a.m.=5:00p.m. Work shall be prohibited anytime on Sunday and Federal holiday Traffic control shall be as per.Cal Trans Traffic Manual. Field adjustments in detouring, shall be accomplished as directed in.order to adjust to.actual field conditions.;` It shall be the contractor's responsibility to adequately barricade and detour this.site. All excavation at'ot'.near the travel way shall be backfilled at the end of-the.work day, for the protection of the traveling public. This permit is only for work within public street right-of- way.. Ingress and egress for'local7propert,ies:shall be maintained at . all times: Prior to work starting, Underground Service Alert shall be contacted at 1-800=422-4133 and an "inquiry number" shall be- provided eprovided to the City Public Works Inspector. Replacement -pavement shall be existing asphalt thickness. ,plus one inch, but not less than 3 inches of AC pavement ..shall be .placed. Class 2 -aggregate base shall be as per existing or .411 minimum (whichever is greater). R41 'If the work is to be performed by forces other than that of the,.utility company's than.that.contracting company will be required to apply -for an additional encroachment permit And - pay the appropriate fee. , :. �..: ..,: �, _ ... .'... •. �: .. � .:' '• � • 'i.��.. -CO •TR. rR[TC N'::� ' COM►L'rRiTCN . " .. . 1 . i, 7":f>�:' .!. u: •. F!;-AN FILE NO;: 'tt. -,rwra raaTCN .. r t. 9`. N MAINf G/ t.l Vii:. 'I HE 'OF i :coop T• ::,.::j;{. �. >I•:; :,,... ,�:: F_ �' `.t a ..i �., •`?t'•'• � ANT _ -_t _ _y. f ;;.:: -J y� s' :., •t:m t: '.l . 1 • .cam .JiL -`s N• (. U i �. -t •v r •t :c. t 'r • *< •J • •t r ri'.'•.� t..... r Q a c. w rt r % !I-. / '1 2 4 1 ` i :, .t_ :e .J:+i t- �,.:'"'•, ( �" I T, c ' 1,- M v t. - J ':Y .T 'J a» _ : .::;Y "i 1 - :1 'I� 't ':'•i •t> t, j .�. ' ":'.! .. � ?i _ l..: c..: , . •'• • . .. ):� o ..:' -' .:c' .'I. .a.. .:L.. p cp::• • dn•: •,... ,,.\�:4t. h . v.6 - r ,.m,� .:. .�... 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Y D o` i < ; •t r` Busine',I-Ye•' ':.: ss •District Affected.s � O::No � ..•:- ..•Y:' ':r' �= •� .r �:..'-: �t Ss�::�-;Jo: Lr .'.�"j'' ^ r :f' ':r• r. +. n'E' , ... .J;' 1,' ��71 Su I Line Affected" :.F:. !Yes �: I �; •.. !,:,� x.. �!: :•r.,-' :1•'.1. i• Yes.1 P of•Valves `Re uired�:�-�s� t J' �.r - 01., -1 �i•�s�,i'` ,te '1ii.,�,\ W .::.: ,I�r:J:�_ ,_�,.. , :,.- ?:•;. �. rye: , >'. : - (• 1:<. x. - 6r., } '.[J: a` HRS:.ta:._6:.._MIN .L':',r+ .ru •> i. �1 G• 't:„y �•t�"' ;ry �.�!l. ,. „r`.0 Reviewed' B �'� :�. �.a'•1�rsA�l6c '.�='%9'l � :., � � ,. - ,:�; a , . ,-' � 1� ► ,�py �. � :mw.- ,� �-,1.,,,;' t Y' .., � i • � •t` .F' : 'J: -� 1'21'.. ,.,. , Y .�K;,•?�{e. n � . f' t, 'Y,/�: `�` �J.: ;'� ..nY C= f T.�" .L- 1 . G. r ''h' >u_ C.P. Reviewed B ={`�t. :;'•;; ',' _.,.. pt-4'�-r. � du.,,T.y._.r�-¢�� i:J,.lt ,�,!. : • fir. _t., is ''i. J• ►' :! :�. TOTA 'i T L F[E7' INST'D � 1 • t.:: ;:,'::;�. ': y.: •a INSTALL MAIN WIT a6 �+' � dcp�rA •Y}".� � •.•7°`•v •: HAT LEAST COVER�BELOW� •� nom, r �T n LT �ST '� � TOTAL FEET RETIRED �' t = •••,,,,,•,; ; '�t�-.:'je � - ,'.r.' ••'' '� . /J PERMIT ISSUED BY:: PE RMIT,NO..�:,:�.�; jt'• BATE MOVFtD; i,'. iDATE MOVED :PATE OF;-;' K/UG�dCS/�✓G :.GL1!�I:RETIREMENT/�G :,... 1r 1. .i= •�_?r _ OB'OFf'JOB�r�.�: TOPER i O� -:i' •i' Imo/ ,.-s:'::,•:...y..,.[ .•, ,•r+.uyt;;i a+t .I;•.t.'r'.: - J a. ,t. ',:-+ 'r;•:.• t: -:D15TR1 +���I�T `h: �!' ;, .,;1:4' :`CRfiMt,i�OR/EMAN t Y r ✓ t, �J <. I CT � : a. r .l 1a-• � LA NE 1'..'• 'L 't !COM JA - I� i ! , ice"' - it•- • r •1 `' v AN STAKEd :COMP Y.FACILITY��' L j / D. �' O. CA P. • a :N /.► .>• .fa:.i': .`a•>.,': EV WED B ,.(. ".F• ` �/; '=i: •is• .. - 9'� .1 •9NSTALL'ED� ',• i •i'•;�i; T_ H4 t :•, rr� q: i S7AKINt3 RC�• , VI - a{ -Et •�: :i:' OPEjt._^::20%OR OVER': :-i.:•'O; (<M.V C'i n " -..� ,,�` ;, +f.L .'1. /�'. bI, >,•- .. ...