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STATE; OF CALIFORNIA <br />DEPARTMENT OF FINANCE <br />LOCAL ALLOCATION DIVISION <br /> <br /> SACRAME;NTO 14. CALIFORNIA <br /> <br /> cat/ 47/. <br />Dace Received by State. <br />Allotment Number . <br />Executive Order Issued. <br />Amount Approved . . $ <br /> <br /> ~ ,,: APPLICATION FOR PLAN PREPARATION REIMBURSEMENT FOR <br /> PUBLIC WORKS PKOJECTS <br /> (Under provisions of Chapter 47, Statutes of 1944 (4th Extra Session) and Rules and Regulations <br /> p~escribed thereunder) <br /> <br />To~ ST&TR DII~CTOR O1' FINAN~: <br /> <br /> This is aL__-X--_-_(otlginal) ............... (mended) application, in triplicate and the authorized agent signing this application <br />on bthal{ o£ local agency hereby certifies that the statements set forth in this and attached sheets are true to the best o/his knowledge <br />and belie£. (Prepared in quadruplicate in accordance with revised rules and forms and fourth copy retained.) <br /> <br />Signature oi pe~n de~g~tad by r.lu~ as "Auto.ed Ag <br /> <br />Tide Dlrezgor <br /> <br />Local Agency's Resoluden No...-2..~?~- ................ Dated Au/~u~.~_~__2_3~. 1~ <br /> <br />1. ~rt Title o[ S~c~c ~j~t icq~re ~nd ~ conat~gAt ~a~~ concrete water reae~ozr <br />2. Description and Scope of Spe~c Project. (~cation, ~pe ~d size of struct~e (attached pre~a~ pla~ or ~etch~ av~able), <br /> <br />availability of necessary had, and other factual data.) __ <br /> <br />Funds or sources from wMCh money iS being made available by Local Agency/or paying one-half or more o/cost of plan preparation <br /> <br />(1) S. (2) <br />Est/mated or Actual Cost: of Plans (Excluding cost o/supervision of construction) <br />a. Preliminary investigation, surveys, etc. (ff any) . . $ <br />b. State/ees (if any) ........ ~ Nolle <br />c. Plans, specifications and estimates . . . <br />d. Total (a~-b+c) ..... <br /> <br />e. Expense incurred prior to July 1, 1944 (if any) ..... $ <br />f. Total actual and/or estimated expense incurred or to be <br />incurred after July 1, 1944 ........ <br /> <br />5. Est/mated Cost of Specific Project <br /> a. Total cost of plans (same as 4d) ....... <br /> b. Estimated cost of inspection, and supervision of construction <br /> c. Estimated cost of construction (breakdown attached) . . . <br /> d. Totalcost of specific project including plans (la + lb + lc) . <br /> e. 6% of cost of project (6% of Item Sd) ...... <br />6. Previous allotments for plan preparation for this project (if any). <br /> (Nos .......................... ) ............ 9- <br /> <br />7. Amount applied for .............. <br /> <br />STATE OF CALIFORNIA <br /> <br />Js~ S. D,~N, D~recto~ o/~in~nee <br /> <br />By. <br /> <br />H. H. Jaqu~, Chief, Local Allocation Division <br /> <br />APPLICATION <br /> <br /> 8. Status of Plan Preparation Work <br /> a. Date started or to start <br /> b. Estimated approximate date for com- <br /> pletion of final plans, specifications <br /> and esa~,t~ d~ae i9~3 <br /> 9. Local Agency Desires to File Claims <br /> for Reimbursement (check which) <br /> [] Monthly [] Quarterly [] Semi- <br /> Annually [] For each 2 ~ % of cost <br /> ~ One lump sum after completion <br />10. Professional services will be rendered by <br /> Local Agency's employees (yes or No) <br /> If by contract, name of per- <br /> son or firm rendering seevice_l~x.~__ <br /> <br /> License No- ~1~ <br /> (If by contract, attach copy of contract) <br />11. Summary o/ Local Agency's postwar <br /> construction program attached. [] <br /> <br /> ~_?_~.75 (See Rules 1561 and 1~75g) <br /> <br />APPROVED <br /> <br /> STATE ALLOCATION BOARD <br /> <br />H. H. JAQUE'rH, Executive O~cer <br /> <br /> <br />