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1905c -NOTE: With proper validation this form constitutes an encroactimerit 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 DATE: 9/29/93 Subdivision Improvement Permit —Class I I I Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION S/W CORNER J8YPMON STREET AND AVENUE 48TH (Street address or Description of Location) PURPOSE OF CONSTRUCTION UNDERGROUND DESCRIPTION OF CONSTRUCTION Sketch (attach construction plans if appropriate) SEE ATTACHED CONDITIONS DIMENSION OF INSTALLATION OR REMOVAL 4 - 6" PVC SHE ATTACHED DRAWING SIZE OF EXCAVATION, IF NEEDED 241 x 51 APPROXIMATE TIME WHEN WORK WILL BEGIN 1014/93 4 APPROXIMATE TIME OF COMPLETION 2 WEEKS ESTIMATED CONSTRUCTION COST $ 50,000 (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 arted. I; Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules an re ulations o the City of La Quinta and to pay for any additional replacement necessary as the result of �is work. a G Signature of Applicant or Agent IRBY CONSTRUCTION COMPANY, P.O. BOX 1010, THERMAL, CA 92274 (619) 398-1505 Name of Applicant (please print) Business Address Telephone No. r HOWARD POLK SAME Name of Contractor and Job Foreman Business Address Telephone No. 163338 Contractor's License No. 2623 City Business License No. LIBERTY MUTUAL INSURANCB ?BI 151 020527 222 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class I I I 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. _a Received by Date 1905 PERMIT VALIDATION PERMIT NO. 1905 DATE APPROVED 9/29/93 EXPIRATION DATE 10/15/93 DATE I ` U By � �� tv Administrative Authority Recorded by 11 + TELEPHONE: (619) 564-2246 NOTE: 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 lou, sewers, water .mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS 10/29/93 Subdivision improvement permit — Class 111 GATE: Minor improvement Permit Class IV LOCATION OF CONSTRUCTION, S/W Corner Jefferson Street, and Avenue 48TH (Street address or oescription of Locations PURPOSE OF CONSTRUCTION - Under9,rg1jnd Cable Instalat on Sketch (attach construction 1 f DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL 4 - 6" PVC SIZE OF EXCAVATION, IF NEEDED 24' x 5' APPROXIMATE TIME WHEN WORK WILL BEGIN 1-0/4/93 APPROXIMATE TIME OF COMPLETION— 2 weeks ESTIMATED CONSTRUCTION COST S 50.000 . (Including removal of all obstruction, materials, and debris, backfilling, corn. Paction and placing permanent resurfacing and/or replacing improvements) _ In consideration of the granting of this permit, the applicant hereby agrees to: V ons I aPproprtateI SEE ATTACHED CONDITIONS Penalties. l defend and saw the City. its autaw" ad agents, officers. �epreaentatim and amployep. harmless from and against any and all panNcus. liabilities or lots resulting from daum or court action and arising out of any accident, loss a happening or occurring as a proxinnte result of any wort undertaken under the damage to persons or prop41ity hermit granted pursuant to this application. Notify the Administrative Authority at 14181112 twenty-four 1241 hours in advance of th tiff when work will be staged. COMON with all applicable City Ordinances. the team and conditions of the palm and all applicable rules La Ouinte and to pay for add ny atticin l replacammeasory u the result of en of the Cety of is wort. Sigrti ture of Applicant or Agent Howard Polk ( Name of Applicant (please print) \% Irby Construction Company' Name of Contractor and Job Foreman 163338 Contractor's License No. Business Address 19) 398-1505 Telephone No. Business Address Telephone No. 2623 City Business License No. Applicant's Insurance Company 1 Policy Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee 3 Permit Fee d Penalty Cash Deposit -Surety Bond if required TOTAL: $ Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. / 9 © 5 DATE APPROVED 9 ' z 9 13 EXPIRATION DATE A6 " IS- ^ 9-9! DATE ISSUED `3 o 3 By -» Administrative Authority TELEPHONE: (619) 564.2246 r r i c �} f � , � [ `• . 1 The following General and Special Provisions are attached to and made a pan of Permit No. GENERAL PROVISIONS The following shall always apply: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work lobe accomplished within City of La Quints 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: ClestedfrocklayingConstructionequipmentshallnotbepermittedtooperateonany paved surface unless fitted with smooth -feted street pads. All mechanical outriggers shall be fitted with rubber street shoes to protea the paving during excavations. Rubber -tired equipment only shall be used in backfill operations in paved area& if the existing pavement Is scarred, spelled. or broken during the term of this contract or if the pavement is marred, City of La Quiff shall request that theca portions of road be resurfaced over their entire width. Resurfacing shall consist ofoof two irtcha (21 of A.0ne coat surfaging 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 Quints 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 sial cutvert a necessary to remove or cut existing drainage structures, City of La Quints sconcrete structures enccumered during excavation which necessitate removal shag be replaced in kind. In the hall be notified prior to commencement of this oaks event.it becomnd es 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 shag be removed fromthe right of way. All paved surfaces shall be broomed dean 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 shag be rortooved prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and Shay be used immediately after backfill. OE -WATER OPERATIONS: If de -watering operations are required and pumps aro forcing wateron City of La Quints 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 isfeft bythe permitteethathe muctcloseastraetfor any length of time, permittee shall contact this office to obtain the necessary permission SPECIAL PROVISIONS The follwing shall apply ONLY when indicated: NOTIFICATION: Permittee shall notify the City at 664-2248 at least 48 hours in advance of starting construction. R2 CASH DEPOSITS OR BONDS: A cash bond o► an approved surety bond in an amount of notion than t shall be furnished in tib name of City of La Quints to cover all work involved in the restoration of the various V Quirtts ~ roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer, This ous L must to Paved prior to commencement of any work on this project.bondbe R3 UTILITY CLEARANCE: (Substructures)Priorto making any excavation within theCityofLaQuintattghtatwaysuthorized 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. UTILITY CLEARANCE: (Surface structures) No work shag be dorm under this permit until all utilities are dear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed wont. R5 PAVEMENT WIDENING: Area between the proposed eonprete gutter line and the existing road pavement shall be ubbass surfaced with - inches of A.C. paving placed en inches of class having an "R'valueof not less than and in conformance with City of La Quints Road Improvers course and Specifications. Ordinance #481. Re 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 (11. R7 GRADES & STAKES: City of La Quints shall establish grades and stakes for the proposed concrete curb and gutter construction. RB GRADE CHECKING: City of La Quints shall chedtgradesupon reeeiptofplanandprofileand/agradesaseatablishedby a licensed engineer. Re CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( fea)shag 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 Quints Standard #207. RIO DRIVEWAYS. A.C.: Driveways shag be constructed as not to after 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 1 -1) of clams aggregate base. Driveway construction shall conform to attached drawing. R 11 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. R1 SIGHT CLEARANCE: Sight clearance of 800 feet in either direction shall be assured and maintained. R13 SOIL STERIUZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall compfyvrith the ��manufacturer's specifications.. <3O COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or City of La Quints may conduct in this area during the period of this permit. Work shall be coordinated with the Slate or City of La Quints forces to preclude delay or interference with State or City of La Quints projects. ® 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 readilyandeorrectly be replaced by a licensed civil engineer or surveyor at the expense of the permittee. A Complete sat of notes showing the ties to these monuments shall be furnished to the City Enginew prior to the removalof ami monuments. ThIs office shall be notified upon Completion of replacement of all survey monuments for orocer aOf ny eleerenee. R16 SURVEY MONUMENTS: Prior to excavation or oeoinninq at construction. all survev monuments shall be two 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 shell be approved through the office of the City Engineer. (Under no circumstances shall excaysting 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 paying operations, any damage to corrected. pavement straight edge shall be 18 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paying operations, any damage to Pavement straight edge shall be corrected. 19 LIMIT OF EXCAVATIONS: Excavations shall be limited to 1.000lineal feet of opentrench before backfill operations must begin. All excavations snail be properly barricaded with lights overnight, on weekends and holidays forth@ 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 15) days. No excavation shall be made unless the construction material is actually on the work site. BACKFILL MATERIAL Backfill shall be free of brush. roots or other organic substance detriments, ; :.;s usefor purposes of producing an adequately consolidated baddill. Any material which the City of La Quinta deems un - suitable (spongy or saturated material) which is encountered during excavation shalt 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 notgreat@rthan throe feet 131 and vibrated using vibrotamperorequivatent equipment. Alternate methods maybe substitutad butinanV � case a relative compaction of 95 percent shall be attained within the g:ructural section of the roadway, V BACKFILL PLACEMENT: Baddill 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 (51 lifts where trenches aro of @xeessive depths. Care is to be exercised that the backfill materiel 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 sacs :aver and the water supply shall be continuous. ttz3/ COMPACTION TESTS: If so required by the inspector, compaction tests shall be made at intervals of not more than 1.000 feet and a minimum of one (t) test on each road. One 11) 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. 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 teats shall be made as outlined in Section 6.3.01 ofthe Standard Specifications, Division of Highways. of California, dated January 1973. State R25 TEMPORARY PAVEMENT REPAIRS: After completion of badtfill 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 shay be placed after a maximum of 3.000 lineal feet of trench has been excavated and baddilloperationscompleted,buts nonsseShall the placement of the temporary pavement exceed a five 15) day limit. R26 PERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed. a temporary patch consisting of two inches 12.1 of SC -800 shall be placed immediately. A permanent patch of surfacing placed on a '' - inch class base she 11 be placed no later than inehesA.C. temporary road repair. days after of R27 PAVEMENT REPAIR: F.A.S.: UPO'ncompletibn of backtill and compaction. a temporarypatch consisting Oftwoinches(2") of cold mix paving 1SC-800) shall be placed immediately. A permanent patch at three inches 13"► of A.C. surfacing shall be placed on six inches 161 concrete base as directed, but not later than fifteen 115) days after completion of temporary paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quints Road ImprovemOMStandards and Specifibations, 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 specdied 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. STREET RESTRIPING: Where street striving is Still visible on streets lobe 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'ihe 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 500feet atanyone 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 contecteo, 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 12") and abovrin size. Seelent shall he aaelirM rn .it 1. 2. 3. 4. SPECIAL CONDITIONS --PERMIT NO. 1905 --- Irby Const. --- In addition to the standard permit conditions, the following, shall apply: All work shall be performed in accordance with the latest edition of the Standard Specifications For Public Works Construction. Permittee shall be responsible for providing continuous dust and erosion control. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently if required. 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 lst 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. Permittee shall assume responsibility for repair of any pavement breakdown at the haul road access to any public.or private street and for any damage to other City streets or facilities. Advance warning signs and traffic control shall be installed and maintained in accordance with Cal Trans Standards. It shall be the permittee's responsibility to detour and barricade this site. Street closures shall not be permitted. A minimum of one,travel lane on paved surface shall be maintained with flagmen at all'times. 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. 10. 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 dry density. , 11. Streets shall be.kept clean. They shall be completely cleaned at the end of the work day and more frequently if required. 12. Pavement replacement section shall be one inch greater than existing, but not less than 3" AC over 4.5" of AB. Special Conditions - Permit No. 1905 Page 1 of 1 fig y �7 6 IS`LIU- 1 _ /3- 717, lqc f _ . II � ` '_ .._ - .. -- _ a .. . .� �� i t � _ ` � I � ._ .. _ .. � _ , -- i� i .. l�l � .. 1 � � � '. Y i _. _ .. -- _ a PICKUP POINT. - EXISTING SWITCH �_;- N O W VAULT: UN 5459S LOOKING: EASE 25'R. 90 1-5'CND.140'W - ES. 1-5'CND.55'W - R. (EXISTING CONDUIT) 4-6"CND.455' W - W. 4' HIGH BLOCK WALL 4' HI H BLOCK WALL 25o EXISTING UN 5459S 42 U.G. RISER UN 19S 0 AVENUE 48TH I5 37.5' so° 708.43' \-4-TCND.115'W- ES. 100'R.42 (EXISTING CONDUIT) \-4-6"CND.190'W - ES. (EXISTING U/G CONDUIT) PICKUP POINT. THIS PORTION IS TO BE DONE BY IMPERIAL IRRIGATION DISTRICT PERSONNEL. IN:4-6'CND.65'ES - ES. 0 25 50 100 SCALE:'1" =30' VAULT: UN 57195 LOOKING: EAST UNDER GROUND F�� Calk mu. TREE 1-800 422-4133 - 1-57CND.160'W - R. 908840-40' PROPOSED RISER N.O. 5007800 SHEET I OF I I3[PERIAL IRRIGATION DISTRICT D�BRIAI. CA aT.aMU vu� NnMN g UNDERGROUND DISTRIBUTION FOR AVENUE 48TH. SMM DIPROVE6IEN1'3 CONOUIT LAYOUT IMPERIAL IRRIGATION DISTRICT POWER DEPARTMENT WORK ORDER SUB LA QUINTA CIR N-121 T ❑5 S R= E, SEC 29 DIV. WORK ORDER No. QQ7800 DIV. CSP NUMBER �— 199 CODE CSP DATED 199 RELATED WORK NUMBER CUSTOMER NAME. IMPERIAL IRRIGATION DISTRICT. SPECIFIC JOB LOCATION S W CORNER JEFFERSON STREET. AND AVENUE 48TH. PLANNED BY: SSN NAME DATE w o Class 575-86-3647 GENE DOMINGO 09 09 93 CODE ICDB Type of est ❑ Type job ❑ Contract work MAJ. CLS.❑ DN• CSP NUMBER 199 R/W required. 1. Imp. req. 1. Overhead 1. Tree trim—prior to const. YES ❑ NO l 2. Work for other 2. Undergrounc 2. Tree trim—maint. CUST ❑ OTHER ❑ 3. Hwy. reloc. 3. 3. Bldg. struct. footings. Pri. 1c�>❑, or 3<t>❑, ext. ft. C�$ Sec.1ct>❑ or 3ct>❑, ext. ft. �$.— 4. Retire plant 4. 4. Grading and trenching. R/W GL NUMBER 5. Est. only 5. 5. Poles towers and fixtures. 6. Other 6. Other 6. Other R/W APPROVED Y/N ��:�:•���I; UNDERGROUND CONDUIT FOR SYSTEM IMPROVEMENTS. Returned to originator Date p / 3 DIV. WORK ORDER No. OQ DN• CSP NUMBER 199 0 ---- Neutral not listed with underground cable. Approved by: Assigned to: C.C. PRI. EXT. $ SEC. EXT.$ Released for scheduling Date Cont. Crew NO.—Line Est.. const. cost $ Div. Serv. Crew No.— Foreman Est. actual cost $ _ Rec:Y/N Est. const. M/H THIS JOB: 00 Ser. con. fee. 1ct�,❑, 3<t>❑, and/or CT ❑ Total M/H assigned Pri. 1c�>❑, or 3<t>❑, ext. ft. C�$ Sec.1ct>❑ or 3ct>❑, ext. ft. �$.— Const. start Date Const. comp. Date City Code Storeroom Code ® County USA THOMAS GUIDE LLJDATE Ticket PAGE & QUAD , ❑ DATE WORK DESCRIPTION AND INSTRUCTIONS INSTALLATION UNDERGROUND CONDUIT FOR SYSTEM IMPROVEMENTS. Returned to originator Date p / 3 DIV. WORK ORDER No. OQ DN• CSP NUMBER 199 BC: Y/N PAID: Y/N ---- CODE Approved by: Assigned to: C.C. PRI. EXT. $ SEC. EXT.$ Line ext. cont. Y/N N Opt No. _ Contract exp. date This cont.' is: — Submitted for approval Date 1091091937 Subject to previous line ext. cont.: Y/N N Returned to originator Date p / 3 DIV. WORK ORDER No. OQ DN• CSP NUMBER 199 BC: Y/N PAID: Y/N ---- CODE Approved by: Assigned to: Date Key punched by: Date I Dist. Crew No. Released for scheduling Date Cont. Crew NO.—Line Est.. const. cost $ Div. Serv. Crew No.— Foreman Est. actual cost $ _ Rec:Y/N Est. const. M/H THIS JOB: 00 Ser. con. fee. 1ct�,❑, 3<t>❑, and/or CT ❑ Total M/H assigned Pri. 1c�>❑, or 3<t>❑, ext. ft. C�$ Sec.1ct>❑ or 3ct>❑, ext. ft. �$.— Const. start Date Const. comp. Date