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APPLICATION FOR PERMIT TO PERFORM WORK ON PUBLIC RIGHT-OF-WAY
0 CONSTRUCTION ENGINEERING DIVISION N° 13704
PERMIT NO:
PROJECT NAME. cv/c 1,�d'C�/ PATE ISSUED. _ ���I--
-- PROJECT ADDRESS O ` kJ. 43 :4Lt `DATE EXPIRES:' J
QUARTER SECTION - DATE ACCEPTED:'" -
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Applca its Name Applegate Sgnature
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WATER LINES LF Dia. LE Dia. SANITARY SEWER LF _Dia LF Dia. MISC _ Manholes , /.X
LF Dia. LF _Dia. ALF Dia LF _Die. _ EA Fire Hydrams7
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Insurancef ❑ Cash Bond -:Artwunt s NamelAddrass IXperson to return bond to:
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Issued by. Comments: z�
UTILITY PERMIT FEE UTILITY PERMITSQUANTITY UNR PRICE EASE FEE $ 50-00
TRENCH(RV!) PAVED '- LF 30.15A.F $
TRENCH(RAN)UNPAVED $
PITS / EA @$1000/EA $
STREETLIGHTS EA @ $50.00/POLE S
TOTAL: $
STREET PERMIT FEE STREET IMPROVEMENT PERMITS QUANTITY ,:r UNIT PRICE BASE FEE $ 50.00
PAVINGSY Q $030/SY $ -
MANHOLES• iii :.:;i EA@$4000/EA $ g
CURB&GUTTER LF @$0.20/LF $
VALLEY GUTTER SF ,@'$0.08/SF S
SIDEWALK SF @ $0.05/SF S
SIDEWALK RAMPS SF @ $0.10/SF $
PRIVATE RESIDENTIAL DRIVEWAY EA @ $25.00/EA $
DRIVEWAY SF @ $0.10/SF $
-
CURB CUT EA @ $200.00/EA $
CATCH BASIN FA @ $40.00/EA $
TOTAL: $
MS PERMIT FEE WATER/SEWER/STORM DRAIN PERMITS QUANTITY UNIT PRICE RASE FEE S 50.00 r
I0
WATERLINE LF @ $0.80A.F $
SEWER LINE - LF @ $0.601LF $
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STORM DRAIN LF @ $1.00/LF $ V
IRRIGATION LF
@ $1.00A.F $ P
MANHOLES EA @ $40.00/EA $
WET TAPS l EA @ $300.00/FA $ t"3 00
TOTAL: $ a i6D
TOTAL PERMIT FEE: $ .25O