147 N. Central Ave. (TR7141)
-----
,Department: Pub 1 i c Works
I' '-~-"
: HAi'DL!rG ¡ ,
I*LI\<\5' " ~'--- i-'
CC;"L,'"O,",',r,o",t "
, ! -- --.":"'_---==- - I
D,iA, = , , ",..'.'- "-,' ",E---,1,.'
--"" '
(CA~E ' --- -..¡
October 12. 1983' Eli --I I
~ITY Of CAMPBEll
.
75 NORTH CENTRAL AVENUE
CAMPBELL. CALIFORNIA 95008
(408) 378-8141
Lars Ko1nes Construction, Inc.
10231 Adriana Avenue
Cupertino, CA 95014
Subject: One Year Maintenance Acceptance
Permit No. 82-105
Location: 147 N. Central Avenue TR 7141 (NC 30)
Gentlemen:
We have made a one year maintenance inspection of subject public
works improvements and find that no maintenance is required.
By copy of this letter, we herew release ~ur ~intenance bond.
Very truly yours,
JOSEPH ELLIOTT
Director of Public Works
, "'" .
I "","
DAVID N. VALKENAAR
Project Engineer
DNv:rg
cc: Norm Samson .' A 92701
Indemnity Co~any of Ca11~rnla, 820 N. Parton St.. Santa Ana C
Bond #628925P
SPEEDOMETER
STOP
ST ART
TOTAL
DIAI\ (
~
" ¿ - 'D .s- DA TE / {J - 6 -- f .5-.
7/ý/ /~7 Æ.J éJ~hd ~--
PAGE NO,
WEATHER
TEMP MIN
MAX
tf5¿ /~
f7p./~ ~ - -- ~r ~
~ :.,. '!4 ~ -..A---'
,
\V~'
J
MBF
WORKING DAY NO,
SIGNED
INSPECTOR
HOURS WORKED
.-----
k:,ev-Zb1-- " '----\':', I
C/' I '
I '
/:
,
i
!
CITY OF CAMPBELL
75 NORTH CENTRAL AVENUE
CAMPBELL, CALIFORNIA 95008
(408) 378-8141
ELLIOTI
~,\,.",'["""G \'~",
, .\",..'"
I '
>r--'--"~"" \
'\ R':~~":V' ,,' ,
August 12, 1982
1--::,':.5
\=--_.. \ ~ -- i-'
'PI' '"
,"--- ,,--" ¡". . ,
U\,-,ê I
--"-¡- ,--,'-"- ,,--
I t ---"..,
,,~-' ,_.-'-~' .
I,
J
Department: Public Works
Lars Ko1nes Construction, Inc.
10231 Adriana Avenue
Cupertino, CA 95014
Subject: Final Inspection and Acceptance
Permit No. 82-105
Location: 147 N. Central Avenue TR 7141 (NC30)
Maintenance Bond Amount: $ 1750.00
Gentlemen:
We have made a Final Inspection of subject public works construction
and find it acceptable and in conformance with City standards. Accord-
ingly, the work is hereby accepted subject to the one-year maintenance
requirement indicated below.
You are responsible for the maintenance, repair and/or replacement of
all work done should any failures occur within one (1) year of this
date. To guarantee this, you must either post a maintenance bond in
the amount indicated above, or maintain your existing faithful per-
formance bond. If you post a separate maintenance bond, your current
bond will be released by separate action.
We will inspect the work in one year and advise you whether or not
maintenance is needed.
Please feel free to call the undersigned if you have any questions.
Very truly yours.
JOSEPH ELLIOTT
Director of Public Works
Ð111~
DAVID N. VALKENAAR
Project Engineer
DNV:
cc: N. Samson, P.W. Inspector
:' Suspense-l yr.
Indemnity Company of California, 820 N. Parton St., Santa Ana CA 92701
Bond #628925P
~QTE: ITEM # 7 OF DEFICIENCY LIST TO BE A PART OF AC,CEPTANCE & ONE YEAR MAINTEr~A~CE
NO. SIDE OF GAANT ~E ~ WE~ERLY P~PE~Y LlNE--RE~VE & ~PLACE W~K (4.5 x 15 ~)...
SPEEDOMETER
STOP
ST ART
TOTAL
DIA~Y PAGE NO.
~
2 -/1);; DATE 7-2 7-)(?,
/'-/7 J) ~ -IxafJ¿ ,
CONTRACT
LOCA TION ~
WEATHER
TEMP, MIN,
MAX,
o/1~~ (Y-,~
--,.A) 1)
~-+~
ðf /2-/ g'; I ~
I MBF
WORKING DAY NO,
SIGNED
INSPECTOR
HOURS WORKED
C I T Y () F C}\ l\\ () II ELL
Page 2
Deficiency List for Permits:
82-105,81-400 and 81-399
TR 7141
147 N. central Avenue
1 )
Northerly property line to north end of driveway - sidewalk: Backfill
and grade at front and back of walk.
2)
West side of Central Avenue - Heat and slope vertical A.C. edge at
edge of gutter.
West side Central Avenue north of Grant Avenue - Remove and replace
walk (3.7 x 6.5).
North side Grant Avenue - (a) Remove sod approximately 12" from parkvlay trees
(b) Raise trees if needed - nursery ball to be at top of sod.
3)
4)
5)
Central Avenue north of Grant Avenue - Complete sanitary manhole as per
Sanitation District No.4 specs.
North side of Grant Avenue - Complete storm manhole and permanently resurface
as per City of Campbell specs.
North side of Grant Avenue at westerly property line - Remove and replace
walk (4.5 x 151 ~)
Grant Avenue storm drain manhole - (a) Enlarge outlet to same size as RCP(12"',
(b) Plaster manhole base for smooth finish and cover RCP wire, (c) Remove
construction from RCP
6)
7)
8)
Norman Samson, Public Works Inspector
5-21-82
NOTE:
Item 7 may be deferred for re-evaluation at the end of the one year
maintenance period. Removal and replacement may be required at that
time, if the work is deferred now.
CITV OF CAMPBEll
~GpanmGm gf rwþlhì Wgrk;
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
~2-/ò~
Name or -0 7 L/. /
Location J IC- / /
IV?
Al, (1~~~ 4- .
Page
of
Date
7-27- gZ
~~~CÆ
c?cé7/a/-If.
:V1~-r~~OI AJ (A~
(Î~~ J?f
~
~~~
I
~uJ
PROJEC ENGINE~
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
þ~~j~ftt ~~. ?J 2 - I () ~
~~c~~~~ tR ') I ¥ /
//7 ÆJ
~~~¿-I
Page
of
Date
?---7-fj?Z
:¡:z l:íJ ~~~ ~ 1 e ~ ~ - ~cc
O-c ..?t A .-<:? JJ ~ - 7- / Z - 7Z
$~~
{/
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
?Z-/Ù~
~~c~~~~ ¡¿? 7/£//
/V7 6~ ð d~-
Page
of
Date
6- 3- 2lZ
-r ?t t?~
S~æJJl jA~
f;-::ß,
~
~~~ (/ ~~? ¿r:'7
~~.~
b-v'-- í/Z
J ~
11
{! f9y1.J / cI
.5/-.~
¡/ S~c:Y
~r~~/ ~J ~/
/
~~~
f ¡A.A..!
PROJJ:T EN~ER
,Y C~'
PROJECT INSPECTOR
CITY OF CAMPBEll
Department of Public Works
CONTRACT IDENTIFICATION
/roject or
Permit No.
yz-/O ê;J-
PROJECT INSPECTOR'S
DAILY REPORT
Name or ~
Location / /r.... 7/y/
/',/7 (l~~~ ~
Page
of
Date
J'- ZÝ-5? Z
ÆJ 0 '.A~
OY~ ~¿a~
d--- Z Y - P Z
~/}D
~-
/'
I AJ-<H--rI ~ ~ ~,,~ 0;' .
~H-
CJw/
PROJECT ENGINEER n
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
~? /()~,-
Name or ~ s//
Location 7 7/
(
/~7 ~L/,L.
Page
of
Date
S-I 9 - Ý 2
f f2¿rJ~-
~~~/ ~ - ~:: ::. ~ji.:-7-
~~cC tVJ¿ ~ - ¿A' '
,
$.~~
,
<.~::/7- f??
P. ec~-
~jJ ÚtJ qߣ
~.J~
çj.--zl-)1 z
F;:'.fl--"--r i .~/.~,
~ fl~ ¿'¿£/~at#.,~.
u~~ "Y ~
~
~
PROJEC~
PROJECT INSPECTOR
r
CITY
OF CJ\MIJßEll
75 NORTH CENTRAL AVENUE
CAMPBELL, CALIFORNIA 95008
(408) 378-8141
Department:
Public Works
E~~:OTT
May 25, 1982
f:" ,',',S '
,
I \ i
1';::- :
,--",.'
¡ CAce :
,1-1
-. _.__..,~....
'X ì-.. !
-~.:~~:' J-- i
H
Lars Ko1nes Construction, Inc.
10231 Adriana Avenue
Cupertino, CA 95014
Subject:
Final Inspection With Deficiency list
Permits: \"82-10~, 81-400 and 81-399
Location:--=t47N. Central Avenue, TR 7141, NC(30)
Gentlemen:
You have requested a final inspection on subject construction work.
There are deficiencies in the work. They are indicated on the en-
closed list. These deficiencies must be corrected to the satisfaction
of Public Works Inspector Norm Samson before we can make a Final Inspec-
tion for acceptance of the work.
Upon completion of the corrective work, please submit a written re-
quest for a Final Inspection and acceptance.
Very truly yours,
JOSEPH ELLIOTT
Director of Public Works
DAVID N. VALKENAAR
Project Engineer
DNV:a
cc: Norm Samson
enc.
- ..,0' .- '^ ..--..", 0 -,
CITY OF CAMPllEll
Page 2
Deficiency List for Permits:
82-105,81-400 and 81-399
TR 7141
147 N. Central Avenue
1)
Northerly property line to north end of driveway - sidewalk: Backfill
and grade at front and back of walk.
West side of Central Avenue - Heat and slope vertical A.C. edge at
edge of gutter.
2)
3) West side Central Avenue north of Grant Avenue - Remove and replace
walk (3.7 x 6.5).
4)
North side Grant Avenue - (a) Remove sod approximately 12" from parkway trees
(b) Raise trees if needed - nursery ball to be at top of sod.
5)
Central Avenue north of Grant Avenue - Complete sanitary manhole as per
Sanitation District No.4 specs.
North side of Grant Avenue - Complete storm manhole and permanently resurface
as per City of Campbell specs.
7) North side of Grant Avenue at westerly property line - Remove and replace
walk (4.5 x 15' ~)
6)
8)
Grant Avenue storm drain manhole - (a) Enlarge outlet to same size as RCP(12"),
(b) Plaster manhole base for smooth finish and cover RCP wire, (c) Remove
construction from RCP
Norman Samson, Public Works Inspector
5-21-82
NOTE:
Item 7 may be deferred for re-evaluation at the end of the one year
maintenance period. Removal and replacement may be required at that
time, if the work is deferred now.
¡
z)
-,,'
.
t \
ý\{\Q.
J
/,~/
/
(¡;¿~- þ ,
w)c;;
/
0/("
Æ..A)\ ~V
yo \}5<' t ~ :r
y \(¡~"
lý
" ~
/,:)
./ /'
....
,/
/} /
í........ .,;'~ --¡)..'
/~;:'",...,
/')
i/
~
, '-'¡'
J
'..
:3)
,:/
// .._,~ /I
',.v<'i' I,"'" /',
//
,:_)
?- )
~
,..';!
v
......A'O.
;;;--- \
., ~.i
/
.;;1
"'Al' /'
,..;{?(,'(~ ,
".. ..
,'b "
,7
/,t
/ ç'}
f.
/'
,I . /' ...
t... ..y J ~-)
'J)
/'
L-;J >"
,
;¿
) .
C !t;,' "
.
~,/
(~
J ~
('
...--c
1/
../
..-,
( fJ.
,
/ L-)
(:::>' ._) ,/ .
,.'
¿"-;;-i
/")':' "
/e -'
¿-"'"
..::..' è~),
,~, ." ~--
r
J
.>~.) ,'4 .--e.)
/
',./ '"
(
.'
J
..7':""
.. ,'"
.. j;, -
/
".1
i
/\
'I
'J..
"
, ,',
~.A.
¿>: /,
/"
7",
I ';
/ ,L- ',"" )
-... -~'./
,...//'
'-,'
'-",
,--,
~,
, --?
/J
¡---:'1.,
/1
I
,
',....-
/
t:) ,(, ...,...
':)') '-
J:.., ( ,;-,
.. ,..;2 ¿,
",;~ í
/' 1
"
i
/
, ,
",' ,
2,'.' j, -¡ Q...
,;"1-
'.'
.j
¡-
..ýl->
d
' 7-~,u-7
/Î
,-;,\
~
----J ,-."
J'; ./"
/7';:?";o' -"
-"""/"/
/'/'
,.i' /' -
)
/~/.
/1' f""';T
, '
,.
,',""
",..:.
,,"".. ", i
/'
¿
)
.',:/
_,.~i
",
"
<:~
'7c-,'""
, r" l' '.'
,1"" ,./
."",<;.' ( "'" , 7"(" "
"t:"', "
/ -r' ."" / /'Y:, r
¿ ,"""
'- ..-~
'/
, /~
/f
".P'
,;;I' /
~..,
,,' ,;,,-" c::.--
/
t/,:?/
,,/ ,"
" ,q,',"/'
~
) Z,' I, vi l ~.
/
/
, .
fh '41"/~
...
'if'-'/<>=
S¡í-"¡j:.J
,i /. 3 q Î
¿I. :/~
.... ",
;1-) /
L .
"'1. ~)
/
,~- ì' ,.","'_c
/) ;<':'"",
J
)-'!/;'/...-' "':"/ r/
7
"-:'-
....
/, /A ,
.,- .
,(/ ,
I '
, '
,?
<'-
" '
-' ,.
/
.'
,¡
,..,,' ,," '
II
-),
~":;.,,,.;-
æ...'
---c;J"" ':;' c:
,,/"';¡""'J i' ".",'
f "J
,,-,
/-
, .
'. ,ì " ,I
.~
"
, .'
-'..'
,," J 7
'-to
.I ' .
i-,,'i'
'v
'-, ';- ;'
./
¡ C," ..~".-
j
;'
..
~~:- ¡;j
~'/,
I'~,
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
'iJ z ~ I" Ù ~~
Name or -p /
Location / /-- 7 I Y
/S/ 7 ",c), (]¿4~¿if ~,
Page
of
Date
$-/? -.9 G-
o (' -/"" i ?JJÆ ~;;pa~;'/J .~
~~~ ~J/ V/~-~. ~
A r) 0 LA. ~ A7- /? ¿r~': g4-~
¡/ !2;ß¿ -
}??~ /'
,
ÁI /><.
f'
;/3y1. /,AJJL ~~ ,
M~
,
~
PROJECT ~ .
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
~ Z -I()~-
Name or ~
Location '7/ ý/
r;:;~ ~ c/ ()~ Á-e .
Page
of
Date
~--- 3-92
Þ ~A1 ~~L /. ~ 2J I~ ~". C ~--=- f Þ.~ gJ¿,¿
,~L'"."c. ~ ~~ .,,4 /-u~ 7<-' - aJdk ~ .
-%J 7R ~ ~ ~ h K-Æ' N ~r~.,¡J~~AJ.
~~'~~.
~~.
.
§4/- 92
vV&/.+ß ~~
1 ¿.vJ.£ ~ ~ß ~ ~~~
~h~
¿;-- l~ % Z
P. ~¿-
"~L.h ~
I
~~ ~¿,,4 ~ /?~C_(J ~
úJ ~/a '% {f,~J ~ % ~
~_...- -'
,
í1Vl-t/
PROtCT ENGINEER
~
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
Project or
?ermit No.
92 - /O~--
PROJECT INSPECTOR'S
DAILY REPORT
Name or
Location 7Z 7/ V/
/$/'7 AJ ~ß.Æ...
Page
of
Date
t/- ¿¿~ p Z
.,(JJ 0 ~~-
~,.....~.
,
~ $--0- :1 z
---~~": k ~r 2f-iZ ;j;; ~ - ~ '-' Ii? " ffLo>~/
~ ?,<c, ~ ~-L~ ~ I' ok~
~--~
'"~~
: 2'/
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
"'rojeet er
r'ermit No. ð;z - é'cJ :r
Name or
Location
ïR 7/"-1/
/¿,¡7/1/ é..,../.r,t.../
Page
/
.
of
Date
/~ A LJ..- 81
,
Arr.vd ¡I"J
.
"ß30- IJS.r;/s-.
C,.,)J". L.¿ ú¡'~Þ-f
,j."... i'f'c/
I'
.. ,'f.' 13".1
~"""n? c£' ¡-
f/q¿ ~,~
JL.....
----
........ ,-~..,. I' "
~ / 1./ <yy:'
M..I"".,.L-
".,."'~[,.,, /"'~U;""""'H£ .....-li 4,'- ~""""". AI., /oc>-d", N;x ¡,..,i.../s.. L~/.<,..
./ I
,'", 'l iia <' -, c.L."'./A/ .1'/;""$1 '¿';¡'Hh1"""~'¿/ .r>rl ,':>~Ch"" 6..-dO,... 1'--l'1l~¡
VI>
A#
A/~o
~H.l~",/ ,ILl ~""pP J/.,.c ¡ 0, S."--- 147
R¿C... ~ )Iv! 4/'¿ f£j Á--/j k C.. 1:-
. S:I'~ £.p I
/.~I dH h "'....",..... /"1 sr........../-".,/ {'
, ~-£ Û ~~~
--,_.J..... ~e./
ó-t..,~ /-. /(1 ~
¿-c.L H
c:.£J.LL'./ IF J?
L.'¿:) ~{ ð'Ld,..
, /
r1
-
;20 Å;"""- /j 2.
J. t
r "", L - A/... -.ø~' '" Ie.
i n-./'/W
.v/ëJ.J - ~ WI< ../.¿ f¿> r..... LHf
en ¡. J."... ¿~ lJ.. '"-0,,1 i.c..:11 J>~l/~ ~ f:...- CO'" ""-'" f~ (~g,k CC'71/"< ¡. -L.
~,¿Æ' ~.: Q
-s/- z IS-??
4/ k~- R~~'~~~
f?êC h/X ~ ~~ ~-
/f..< /' :x é'....,
(ì~c¡J
Ii,'
~.
,U,{)
PROJECT ENGINEER
PROJECT INSPECTOR
CITY OF CAMPBELL
De;>artment of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
92 -/C7~""
Name or~:£.
Location J.
7/v/
/ c/7 ~
-I ¿f Page
('~~
Date
of
¥,-/7 - ? Z
.Á.J é) ~
/
~~
~ ß~-~~
~~
/3 /j./1,,- 92-
,
Å"ù ó-ø/L - .Jot
6........"',¿â.L'/'
~~Æ,~q~ ~
/~ AI'" 11;z
14 ~.,f -
,i ,JL £L""',"I...".æJ
~"'cÞ...é. Æ'~I-- Q
,
/~- A¡"I' ß:2
lVv Jt4,....1 - "J;' i.~_...,',-=-~L./
~~~~4 Ý-~
c
/' 4-,.. ß l..
1-:...
-.-,,-
¡,("
....~{I.
C<>
k...
r'
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
% 2 -/0 61-
Name or 7£. '7 s/ /
Location /
/'/7 /CI.
~;/~ L. Page
Date
of
i./ ~---&'Z
AJð (~~ ~ p~~
, ~ Þ!~~/
~~L
~~~ ~~~.
/ ,.
~~
-V- 7- 9 Z.
AJo IA~~
£-<-L-,4 I ~ r-c d1 .
dJ-6 ..-ß~ --e-ø :11/
~
d-~- y Z
A.)tJ ~-
riA ¿d
~
/'
~""""
PROJECT INSPECTOR
CITY OF CAMPBEll
Department (7f Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or -
Permit No. 512 -/O~
Name or ~ V
location 7/ /
,It/? ÆJ ~Ir~,.æ~.
Page
of
Date
3~Z9-Ø¿
ÆJo ú~ £~L ~ ~ß-i?~'
dJ! A~~4'~.
~~.
3- 3,1- f? 2-
Æ)o ~ L- -4 ~~,
drr-rt .fi ~' ¿t ¿J
~
, ,
~-
~
L/-/~ r¡¡ Z jZ~ -
-/. k ~ / ~.-J.-) tv-<-~ ~ ~~ c, tf-~. IJ , aL¡
'1s ~ ~, ~ ("1~c~ I .ß~ -~J Lu--d ~ ~~
. ,)
~-1~~:U r ,LL
~
,
«- z - 'i? 2- ..:::i/~ -?<Z .
A) ~ ~ ~o - A ¿-cA!~~ -, ~ Aff ~-eL;:t! ./
~e:??; --.......
,.
~~GINEER
~
PROJECT INSPECTOR
CITY OF CAMPBEll
Department of Public Works
CONTRACT IDENTIFICATION
Project or
Permit No.
92~/OC
PROJECT INSPECTOR'S
DAILY REPORT
Name or 7/E' '7 ý/
Location / A.- .7/ I'
) V7 ~J.
~M¿
,
Page
of
Date
3- Z 7-8 7
Á;;'fJ l~rL-
d¿~
d¿; ~AJl
Â.,.~
d', Z c/- )? z
~ &~/J L -
m #¿~g - I?A /¿? ~ß fl;:/-t7 h1 d /' ~ C, ç ¿fc) ø ~.
h1¿?ø - ~J~~ %; C/ âziZ'~ ~ /' ~td.n/ ~ ~
~ ~~~ ~ef/
'1ær'
lL~~
3-? !:;.--?2
Ú/¿ {?~~ M~
F~j} (}, tf-; IU .I ~ 15.
~ ---L!~ß/
/ß~
11!:o~ ENGINEER
~
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
7J z - /0 ~~
Name or .-,----þ '7 , / /
Location I/C /Y 7' /
/'/7.ß
~4/llÎo-e.
Page
¡
of
/
Date
,$-/.5' - ~ Z
.IUD ~
~~
13~edj)
~
ß-/8-9Z
vtJÐ ~
~ tu.d
rLIl ~~ ¿jl
~
IJl 1'1", £, 2
M.
l~v,,'
J..l
¡,....¿ f - JoJl £I'---Oc.'I<.i_~/
~~æ~
r¿
'VUJ
PROJECT ENGINEER
~ PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
~~~~ftt ~~. 512 - I () :;r
~~c~~oo~ 7? ? J V /
PROJECT INSPECTOR'S
DAILY REPORT
!V74. ~~,
Page
of
Date
3--- Y --'¿F¿'
.>'a-w .R g L7,.-:' C. ~ /; >I' ~
p:Y
~ ~ -#:t!~
~~~- ~--
,.
3-7'-? Z
AJo ~.2-~qJ-;~:; -,4:::
C2 ~~ ~~ --.up' C. ~ -,^ß-
y
~~J . &6 ~-;4?~
ø-f.""",,--..--
,
£-/¿-,?Z
A--:J D ~ ¿~ .¿ 1~ ~-JL ? ðof! ~
~ ~~-r--Þ~ß
J /kt
~
~cr'p
PROJECT INSPECTOR
CITY OF CAMPBELL
Department of Public Works
CONTRACT IDENTIFICATION
~~~~ftt~~. ~rr~f ~ ¿! 2 - leJS
~::~~~ ~? / s/ / ~ ~ r/ t:;:.þJ ~ .
PROJECT INSPECTOR'S
DAILY REPORT
Page
of
Date
2-/- 51 Z
'V.+:ß cf?~~ / /~ /:-,L--- ~ ~ ~
~Ifk ~ 'Yt.o-- L'¿&"'. ~ ~~a,..4.J
~~'.ß~#4! I ~,;,/~~þ,a¡~ /A~
~~¿þ-=~ )4)' ~~ ..~~ ~ ~ ~
L,Yu ,~~ f;z .. ß~ ~~j~ -! 4 ~ ~/.
----?/- - ~
Æ&I ". ~
,
Z- ---~... ~ lJ Z
/)iQ ~jl ~~~ l»- ('~~ ~ ~-A,~~
'~/A~/
P OJE~
PROJECT INSPECTOR
EX C A V A T ION PER M I T
~
CITY OF CAMPBELL
DEPARTMENT OF PUBLIC WORKS
75 N. Centra 1 Avenue
Campbell, CA, 95008
(408) 378-8141, ext. 220
APPLICATION
""It ~~
Ref. file :.
App. date -
,.." ~u " -" .--
Expires --
'7 / '-/ I
Tk'
z:
8
~
U
<oJ
VI
VI
-
:r
~
Application is hereby made for an excavation pennft in accordance with Campbell Municipal Code. Section 11.04.
A. location of work: ;1.,1, ßI1 ~~b('
B. Nature of WOrk: &J\ D d iA'U.~-.i::ö
<oJ
~
i
u
0
~
C. Attach three (3) copies of a drawing showing the location. extent and dillll!nsions of the work. The drawing
shall show the relation of the proposed work to existing surface and underground illprovenents. llhen ap-
proved by the City Engineer. said drawing becomes a part of this pennit.
D. The General Conditions for all pennits are listed on the reverse side. Special Provisions for this pennit
are listed below. Failure to abide by these conditions and provisions may result in Job shut-down and/or
forfeiture of Faithful Perfonnance and Cash Bonds. (See General Conditions 1 and 2.)
!r;
co
::;
-'
"-
"-
co
E. An application fee of $25 INIst accompany this application. This is non-refundable and w111 be applied toward
the total pennit fee if the pennit is consunmated.
Addres 5
Addres-s
....:>
State Contractor license No.
3,~
*NOTE: The Contractor 8Usí
t')() ~~~ 4
ractor's l1cense and City of Cupbell Business license.
SPECI.~L PROVISIONS
-- 1. Street ~hall not be open cut for underground installations. I«nhun cuts ..v :>e allCJ\o/c': for
conlW'cti,,"~ or exploration holes. Such cuts 8Ust be specifically ,,"provcc by the Ins'>eCtor.
2. Pavement construction or restoration shall be:
a. As shown on plans.
b. Existing section plus 2-inches A.C. with 4-inches A.c. on l2-inches R-78 base rock or
g-inches A.C. held as a lIIinimum section.
c.
Note - Existing chip seals shall be replaced to confonn with the surrounding pavement surface.
3. The hours of work are limited to outside the hours of 7-9 a.lII. and 3-6 p.lII.
v
4. Work to be staked by a licensed land Surveyor or Civ11 Engineer and two (2) copies of the
cut sheets sent to the Public Works Department before starting work.
z
8
~
U
<oJ
VI
VI
X
~
...
t;
-'
i
0
u
0
~
>-
I-
5.
NOTICE MUST BE GIVEN TO THE CITY AT lEAST 48 HOURS BEFORE BEGINNING WORK. PHONE 378-8141. ext. 220.
Amount
Receipt No. 's
?~qO -Ii::
~(rD ~/~)ß2- "2.q;"J~P
ý/t! . ~~.
// 3 ~C4...- I
cr/ý3
Z-¡q-f-z.-
D«te
~
PERMIT APPLICATION FEE $ 25.00
BOND FOR FAITHFUL PERFORl'ANCE $ I,Oele? OD
CASH DEPOSIT REQUIRED $ 2 CO, ðD
PERMIT FEE (J/j% of F.P. bond) J", /}¡J. $ z..r..f_\/OD
Approved for issuance .vn.4/æ;tj'{;1ÆA.¿ c/.~
for City Engineer
~
ACCEPTED
ies by affixing his signature to this pennit to hold the City of Campbell. its
, oyees free, safe and hannl ss from any claim or demand for damages resulting
s peTit. ./- ~,t9'¿.
Date
J:, ) 5),
Itf~J
_....--,,/'
,'):
Acct.
3372
3370
3372
3372
3372
3372
3372
3372
3372
~372
~j72
72
3373
3373
3373
~
3372
3521
352'1
3521
CITY CLERK
P1ease co11ect and receipt
for the fo11owing monies:
P.W. Fi1e No.
Items
Pre1iminary Environmenta1 Impact Report Fee ($70.00)
Storm Drainage Area Fee per acre ($1,500 R-l;
$1,650 Multi-Res.; $1~800 all other)
P1an Examination and Construction Inspection Fee
(3-1/2% of va1ue
Tentative Parce1 Map Fi1ing Fee ($60.00)
Tentative Tract Map Fi1ing Fee ($120.00)
Fina1 Parce1 Map Fi1ing Fee ($120.00)
Fina1 Tract Map Fi1 ing Fee ($100.00)
Vacation of Pub1ic Streets and Easements ($270.00)
Assessment Segregation or Reapportionment ($250.00
for first p1us $80.00 each additiona1)
Lot Line Adjustment Fee ($160.00)
Certificate of Comp1iance ($180.00)
Map Revisions to Map Companies ($10.00)
Copies of Engineering Maps and P1ans ($0.50/SF)
Work Area Traffic Contro1 Handbook ($2.00)
Project Plans and Specifications ($10.00)
Excavation Permit App1ication Fee ($25.00)
Excavation Permit Fee (3-1/2% of va1ue)
Cash Deposit
Faithfu1 Performance Deposit
Maintenance Bond Deposit
TOTAL
Name I ~ ~l ne-6 ~J)t sf-. IIL(' J
Address lO.;t.3\ rtJJU ~D~ 0 ' O..Lil ~ Q, Úoif~
- I
~.;:l-J Os-
Amount
1>:;' S-. ð-D
$ ,;JS. &-D
Phone ~53-t?2PJS-
Zip -9~7J J L.J-
FOR
CITY
CLERK
ONLY
Receipt No. 7 '-19 0
Amount Paid :R c:2 ~ oc;
Received by ~ ~
Date .:2 - t.f- -9 ~
January, 1981
-.0:
Acct.
3372
3370
3372
3372
3372
3372
3372
3372
3372
3372
72
-"72
3373
3373
3373
3372
~
é§)
352,1
3521
~ . f~
~- /ð.s-
P.W. File No.
CITY CLERK
Please collect and receipt
for the following monies:
Items
Preliminary Environmental Impact Report Fee ($70.00)
Storm Drainage Area Fee per acre ($1,500 R-l;
$1,650 Multi-Res.; $1,800 all other)
Plan Examination and Construction Inspection Fee
(3-1/2% of value
Tentative Parcel Map Filing Fee ($60.00)
Tentative Tract Map Filing Fee ($120.00)
Final Parce1 Map Filing Fee ($120.00)
Final Tract Map Filing Fee ($100.00)
Vacation of Public Streets and Easements ($270.00)
Assessment Segregation or Reapportionment ($250.00
for first plus $80.00 each additional)
Lot Line Adjustment Fee ($160.00)
Certificate of Compliance ($180.00)
Map Revisions to Map Companies ($10.00)
Copies of Engineering Maps and P1ans ($0.50/SF)
Work Area Traffic Contro1 Handbook ($2.00)
Project P1ans and Specifications ($10.00)
Excavation Permit App1ication Fee ($25.00)
Excavation Permit Fee (3-1/2% of va1ue)
Cash Deposit
Faithful Performance Deposit
Maintenance Bond Deposit
TOTAL
LA ~s /!o ¿ ¡vi e s Co /1;1.5 r
Address /0 :;. 3 J /If:? ¡¿ 111/11 /J A- V ~
(1. U Pð~ T//J/O
Name
Phone
Zip
FOR
CITY
CLERK
ONLY
Receipt No. 'g/+3
Amount Pa i d g -'fL/-S C> ê)
Received by 0 ~
Date ~ --- --':>---- '3;J-
Amount
.;zY'5.òO
.,ß /-. ct--ð -' 0 Ò
$
7' tzLs-. c) ù
:2 S- 3 -J? 235-
?S"ð / ~
January, 1981
C~~RUC..T.,IO. N C,OST,~S~.IMATE ,.:0:-.
t:.:z.9- >1'" ,.,£ ð' - -,/ ~J c::> Da te 2' - q ~ /!(' z:-.
-r/~ '7) 'r"'/ /~;1 ./J J.... 4,~'/BY /' ?
.
Surface Construction
Clearing and Grubbing
Sawcut Concrete
Concrete Remova 1
Curb and Gutter Removal
Inlot Drain with Pipe
Curb and Gutter
Sidewalk
Dri veway Approach
Handi cap Ramp
Barri cade
A,C. Pavement inc. Excavation
Adjust Manhole to Grade
Adj us t Handho 1 e to Grade
Monument Box w Monument
Street Tree (15 gallon)
Pavement Stri pi ng
Pavement Legends
Stop, Street Name or Other Si gn
Pavement Markers
Pavement Key Cut
Street L i ghti ng
Electrolier
Conduit
Conductor, pa i r
Pull Box
Storm Drainage
12"or15"RCP
18"or21"RCP
Street Inlet
Manho 1 e
Break and Enter Manhole
Revi sed 1/20/82
Lump Sum
7 L.F. @ $ 3.50
IS:2 S.F. @ 2.50
J/) L. F. @ 8.00
EA. @ 400.00
III L.F. @ 12.00
~. M' S.F. @ 4.00
,.~',
ztlt S.F. @ 6.00
/ EA. @ 600.00
L.F. @ 40.00
S.F.) ($1.10) ( -")
EA. @ 400.00
EA, @ 300.00
EA. @ 300 .00
3 EA. @ 175.00
I.F. @ 0.80
EA. @ 100.00
EA. @ 100.00
EA. @ 12.00
L. F. @ 5.00
EA. @ 3,000.00
L.F. @ 9.00
L.F. @ 3.00
EA. @ 250.00
I.F. @ 45.00
L.F. @ 55.00
EA. @ 1,000.00
EA. @ 1,200,00
EA. @
500.00
TOTAL ESTIMATE
USE FOR BOND
= $
'2 it,,; 6ö
-'/55, [~:'
gg8/0D
1..33 Z, ¿) 0
It.Jg~,¡)!)
, I ',1 (, " ,
, ~. ,~ " . .) .,
&:'DD, L1D
/"., ...-: ')~)
_. ~ 0..
$ 6 7(J~. :$e>
$ lorN}, a iJ
1 ~A(Ÿ'f. 1/ -I, ~tJ)
...I'>p N.c,'l
RESOLUTION NO.
BEING A RESOLUTION APPROVING FINAL MAP
OF TRACT NO. 7141, NORTHWEST CORNER OF
CENTRAL AND GRANT AVENUES
6112
WHEREAS, there has been submitted to the City Council of the City
of Campbell a final map of Tract No. 7141, northwest corner of Central
and Grant Avenues, for approval;
WHEREAS, the City Engineer has certified that the map conforms to
Subdivision Map Act and City Ordinance;
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Campbell that said map be and the same is hereby approved and that any
real property offered for dedication for public use is accepted on
behalf of the public in conformity with the terms of the offer of dedi-
cation.
8th day of
June
, 1981,
PASSED AND ADOPTED this
by the following vote:
AYES: Councilmen: Chamberlin, Podgorsek, Paul, Doetsch
NOES: Counc il men: None
ABSENT: Counci 1 men: Hammer
APPROVED:
,7'"--- /
.</ / " .
, /~/ -',//' " ."..'/.../",~. ,,/, :,/ . ! /
Ralph/boetsch, Sr., Maýor
ATTEST:
,/1,
'1 ~ ' ''/ /
',' -/.,; ¿<"'... // " /(//(/'./
Pflf£~~o.QaI~Mr~~1~;.ty C1 erk
:¡~/) tX>~C'T COPY !)oF THE ORIGINAfI
., '
:.~ "', ",';'0'-
._.~~
;œ1'U'~~/P/ -..
Sanla Clara Valley Waler Dislricl ê
FLOOD HAZARD REPORT
FC 59 1031077) N c(--:; 0 )
5750 ALMADEN EXPRESSWAY. SAN JOSE, CALIFORNIA 95118. (408) 265-2600
June 1, 1981
RECEIVED
Jill.
u,'l .¡
State of California
Division of Real Estate
185 Berry Street, Room 5816
San Francisco, California 94107
!,' f
PUBLIC Wo
t., .'Me¡:: RKS
'--RING
Gentlemen:
A request has been re California Land Title Company to prepare a flood hazard
report relative to ract 7141-rõcatedWítJilTi-theC:rty--Qf-CampbeTr------
in the Los Gatos . nie - --------------- -----~---W~tershed.
------_._,-,~---_._-------
.u,-------.--~--
The following report is based on datil available to the Santa Clara Valley Water District and is not intended to supplant any req,wed
report from the Federal Insurance Administration.
1x.J The site would not be subject to flooding III the event of a 1% flood flow from a Distllct Facility under either present ur
foreseeable future conditions. (This is a flow having a 1% chance of being equalled or exceeded in any year.)
!] The site would be subject to flooding from Creek in the event of the 1 ~i flood flow.
---------.-- - -~._._--_. ----
It is estimated that the channel has a present capacity to pass a flow which ¡'¡is a % chance of beinçt ,'quailed nr
- _n- -
exceeded in any year. No assurance can be given as to date at which flood protection will be provided. Any Iliformation
available to us regarding possible future protection is given below under "Additional Comments".
0 A flood hazard to the site does not exist under present conditions. A 10/0 flood hazard to this site may develop as
conditions change.
Additional Comments:
For information concerning the hazard from and disposition of local or surface storm water within and adjacent to this site, plea,e
contact the Ci !y-. of CamJ2JLelLJ~\lQ~-i.~- Works - DeE~~tm~.!_- ---- ------------ - ___n--
cc: California Land Title Co.
I Public~orks Dept, City of Campbell
Sincerely yours,
ORJíbU~Al. SiGl'i-';'>.J Þ ì
W. F. Carls(:11 f
Division Engineer
Design Coordination Division
CITY OF CAMPBELL
MEMORANDUM
To:
BUILDING DEPARTMENT
Date: ,\' /... '/ .- 1 I::' - ¡
From:
PUBLIC WORKS DEPARTMENT
Subject: PUBL I C WORKS DEPARTMENT REQU I REMENTS
----------------------------------------------------------
,
The requirements of the Public Works Department have been satisfied for
the following development:
APPLICANT \~, "¡-',' ¡\ I' ¡:T / ;.(C[ ~ i¡:-(~ t_ot,.JST, ¡I f\JC.
""-.'_"~-- ... -.,'--- -----'-'
BUILDING ADDRESS'. . ',ji t!..l\: " (' ¡ /" t I-j
COUNTY ASSESSOR'S
PARCEL NUMBER --, , , ' ' "r I 9
I ')., " 1 ,-"- I c..:
APPROVAL NUMBER T ~ . it:- '7 (.t- ¡
,. -. ""'"
PUBLIC WORKS FILE NUMBER!. .' "-)(. "
.,..,.
JOSEPH ELLIOTT
DIRECTOR OF PUBLIC WORKS
By: ,...,
~
Date:
TO:
Acct.
3372
3370
3372
3372
3372
3372
3372
3372
3372
3372
3372
3372
3373
3373
3373
3372
3372
3521
3521
3521
3510
CITY CLERK
P1ease collect and receipt
for the following monies:
P.W. File No.
Items
Preliminary Environmental Impñct Report Fee ($70.00)
Storm Drainage Area Fee per acre ($1.500 R-l;
$1,650 Multi-Res.; $1.800 all other)
Plan Examination and Construction Inspection Fee
(3-1/2% of value
Tentative Parcel Map Filing Fee ($60.00)
Tentative Tract Map Filing Fee ($120.00)
Final Parcel Map Filing Fee ($120.00)
Final Tract Map Filing Fee ($100.00)
Vacation of Public Streets and Easements
($270.00)
($250.00
Assessment Segregation or Reapportionment
for first plus $80.00 each additiona1)
Lot Line Adjustment Fee ($160.00)
Certificate of Compliance ($180.00)
Map Revisions to Map Companies ($10.00)
Copies of Engineering Maps and Plans ($0.50/SF)
Work Area Traffic Control Handbook ($2.00)
Project Plans and Specifications ($10.00)
Excavation Permit Application Fee ($25.00)
Excavation Permit Fee (3-1/2% of value)
Cash Deposit
Faithful Performance Deposit
Maintenance Bond Deposit
'Fìy-~ h' dva..V\t ~a ì V\T- ~,.::::- '
TOTAL
----'-------
Name L-AR.S {LDW6S Co¡..JST'j It-JC",
Address_I 0 2- 3 I A- nlZ- I A~A Ave.
I c.uP.
,
FOR Receipt No. ;;l7;¿ì
CITY Amount Paid liS /J ;LO / tJO
CLERK
ONLY Received by a- ¡b/
Date S-~/-91
Phone
Zip
ÞJ .Co (3~
Amount
C)~
100
$
l <35'
L 2.0\
'550/4--
January, 1981
COUNTY SANITATION DISTRICT NO.4
OF SANTA CLARA COUNTY
SERVING RESIDENTS OF
CITY OF CAMPBELL
TOWN OF LOS GATOS
CITY OF MONTE SERENO
CITY OF SAN JOSE
CITY OF SANTA CLARA
CITY OF SARATOGA
UNINCORPORATED AREA
100 East Sunnyoaks Avenue
Campbell, California 95008
Telephone 378-2407
May 21, 1981
City of Campbell
Public Works Department
75 N. Central Avenue
Campbell, CA 90508
Re
TRACT 7141
(Central Avenue)
This is the District's "clearance letter" for the
recordation of subject development.
This District has reviewed and approved the plans
for the sewer system servicing this development.
Fees due this District have been paid. Bond,
adequate to insure subject sewer system installa-
tion, has been posted with this District. In short,
all of the District's requirements for tract
recordation have been met.
Very truly yours,
stephen H. Goodman
Manager and Engineer
~-Q-~~
FoVL.-
By P. R. Nichols
Assistant District Engineer
PRN: j f
PACIFIC
GAS
AND
ELECTRIC
COMPANY
..
~~è.9~
¡
-¡
10900 NO. BLANEY AV¿NUE
CUPERTINO, CALIFORNiA 95014
(408) 253-2010
.Nay 1 3, 1 981
.Mr. Joseph Elliott
Director of Public '¡Jorks
75 N. Central il venue
Calapbell, CA 950CJ8
.
Subj ect:
Easement Approval for Tract #7141
Dear Sir:
The Public Utility Easements shown on the final copy of the tract
presented prior to recording, are adequate and satisfactory for
the installation of this company's gas and electric distribution
facilities. Should you have any questions, please call Mr. Don
Dixon at 253-2010.
Sincerely,
Jk:Jt-~
A. St evenson
District Electric Superintendent
PTaT
Viera Corporation
Tract File
@
Mr. Joe Ell i ott
City of Campbell
75 North Central Avenue
Campbell, CA 95008
Pacific Telephone
1333 Lawrence Expressway
Building 300
Santa Clara, California 95051
~t(:êlv
}to' t /);
Ifl. .
May 5, 1981
'PI/. .01
'~A,Ï:iLIC f¡i .
SV'f{J/Nf/{Jlif(S
t.;/(/IVC;
RE:
Tract-Metcalfe Mannor
Dear Sir:
We have no objection to the P.S.E.'s as shown on the attached map.
P. S. E. I S do not, however, cons titute "an easement acceptable to the uti 1 ity, "
as described in our Rule 16 I.C.2b.
It may, therefore be advantageous for the developer to grant our Company a
Right-of-Way for a portion of the telephone facilities to be placed on the
property served. Any arrangements for such an easement will be made directly
with the developer.
Yours very truly,
¿¡ / Æ. ~~~
W. R. JoUr/'
Engineering Manager
SLG/pa1
cc:
Vicra Corporation
125 E. Sunnyoaks Avenue #202
Campbell, CA 95008
Lars Kilnes Construction, Inc.
10231 Adriana Avenue
Cupertino, CA 95014
MEMORANDUM
To:
From:
CITY OF CAMPBELL
ARTHUR A. KEE
Planning Director
Date: March 2, 1981
JOSEPH ELLIOTT
Director of Public Works
Subject: Tentative Subdivision Map
Lands of Metca 1 fe
- - - - - - ~P~ 279-40-18 & J 9
-------------------------
The following conditions of approval are recommended concerning the subject tentative
subdivision map submitted by VICRA Corporation
Installation of a sanitary sewerage system to serve all lots within the sub-
division in conformance with the proposed plans of the County of Santa Clara
Sanitation District No.4. Sanitary sewerage service to be provided by said
District No.4.
-L.
4 .
í.
2 .
Installation of a water distribution system to serve all lots within the sub-
division in conformance with the plans of the San Jose Water Works.
Water service to be provided by said water company. Fire hydrants and appurte-
nances shall be provided and installed at the locations specified by the
Fire Chief, Fire Department, City of Campbell. Fire hydrant maintenance
fees shall be paid to City at the rate of $195 per fire hydrant.
Subdivider shall create or provide any public service easement and any other
public utility and/or public service easements as may be necessary for the
installation of any and all public utilities and/or facilities.
3 .
Compliance with the provisions of Title 20, Subdivisions of the Campbell
Municipal Code.
Subdivider to pay Storm Drainage Area Fee.
6. Subdivider to furnish copy of Preliminary Title Report.
Subdivider shall (install street improvements and post surety to guaranty
the work) (execute an agreement and post surety to install street improve-
---. ments in the future and agree to join a Local Improvement District).
Dedicate additional right-of-way to 30 feet from centerline along Grant Street
7. with a 20-foot-radius return at Central Avenue.
C.C.&R.'s to be approved by City Engineer to insure provisions for maintenance
-1L.- of buildings and common area.
Provide a grading and drainage plan for the review and approval of the City
Engineer.
î.
.liL .
Obtain an excavation permit and pay fees and deposit for all work in the
public right of way including installation of a driveway approach and side-
walk on Central Avenue; removal of existing driveway approach; installation
of a handicap ramp at the corner; installation of drainage facilities, street
tree and e1ectro1ier as required; and any other work in the public right of way.
By: BILL M. HELMS
Engineering Manager
TO:
Acc t .
3372
3370
3372
3372
3372
3372
3372
3372
3372
3372
3372
3372
3373
3373
3373
3372
3372
3521
352'1
3521
C!TY CLERK
Please co11ect and receipt
for the following monies:
P.W. Fi1e No.
Items
Pre1iminary Environmenta1 Impact Report Fee ($70.00)
Storm Drainage Area Fee per acre ($1,500 R-l;
$1,650 Multi-Res.; $1.800 all other)
Plan Examination and Construction Inspection Fee
(3-1/2% of value
Tentative Parcel Map Fi1ing Fee ($60.00)
Tentative Tract Map Filing Fee ($120.00)
Final Parce1 Map Fi1ing Fee ($120.00)
Final Tract Map Filing Fee ($100.00)
Vacation of Pub1ic Streets and Easements ($270.00)
Assessment Segregation or Reapportionment ($250.00
for first plus $80.00 each additional)
Lot Line Adjustment Fee ($160.00)
Certificate of Compliance ($180.00)
Map Revisions to Map Companies ($10.00)
Copies of Engineering Maps and Plans ($0.50/SF)
Work Area Traffic Control Handbook ($2.00)
Project Plans and Specifications ($10.00)
Excavation Permit Application Fee ($25.00)
Excavation Permit Fee (3-1/2% of value)
Cash Deposit
Faithful Performance Deposit
Maintenance Bond Deposit
TOTAL
Name LAR-S ¿oL!\J65 Co~. IkJc... Phone
Address IOZ ~ I A-l:>£ fAIJA A\J5. CUPGeïtNl> Zip
FOR
CITY
CLERK
ONLY
Receipt No. Ob '1~
Amoun t Pa i d ,g; /..;) 0 00
Rece i ved by Q... ~
,;;2 - ~3 - 8/
Date
Amount
$/20
$ ---1 2.0
9St>~
,'~----