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er 0 <br /> w <br /> ST•AWDARD ENCROACHMENWERMIT APPLICATION <br /> TR-0100 A(REV. 11/94) / <br /> 22.Description of work{contlnusd) <br /> FEE CALCULATION-FOR CALTRANS USE <br /> ❑ CASH/CHECK ❑ CREDIT CARD ❑ EXEMPT ❑ PROJECT EA _ —_ _ _ _ <br /> ❑ SET FEE ❑ AS ❑ AX ❑ DEFERRED BILLING (Utility) <br /> CALCULATED BY t�I (Z) <br /> REVIEW 1. FEE/DEPOSIT DATE 2. FEE/DEPOSIT DATE TOTAL FEE/DEPOSIT <br /> 1. HOURS @ $ $ $ <br /> 2- HOURS @ S $ $ <br /> INSPECTION <br /> 1. HOURS 0 $ $ $ <br /> 2. HOURS 0 $ $ $ <br /> FIELD WORK <br /> HOURS 0 $ $ $ $ <br /> CASH DEPOSIT IN <br /> LIEU OF BOND $ $ $ <br /> TOTAL COLLECTED $ $ <br /> s <br /> CASHIER'S INITIALS <br /> The current hourly rate is set annually by Headquarters Accounting. District Office staff do not have authority to modify this rate. <br /> DATE AMOUNT <br /> PERFORMANCE BOND ❑ <br /> $ <br /> DATE AMOUNT <br /> PAYMENT BOND ❑ <br /> $ <br /> AMOUNT <br /> LIABILITY INSURANCE REQUIRED ? ❑ YES ❑ NO <br /> S <br /> EP 94 0009 <br />