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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date J I- / - 0 '-I
. .
Time / I 3 () Jm Received by
(phone, person)
Location of Work to be inspected b J D {.,.../ / J rz
Name of person requesting inspection vJ.:?\. Ie ~r C1 v.
Add f ...,'., rL. d /.(,. sr Ph N (1/ 2 (/~<'I t4
ress 0 person requesting inspection _ -1 !L _v one 0- 7) I
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav @c:.--V"'''l. r- ~ ,/"'
INSPECTION NOTES
Inspected Date /1-/-0(.,/ Time 11,:3u 1.......sy 7/7
Remarks
<<.en v.............. vv'e<<,.. r'r s e./VtC~
RESTORATION REQUIRED
YES
NO
\'\
~
a
~
~
/'3 ,"-.
,
t-31S
., "'z
~ It Ik> t f,,,l
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC ~ Other r 0~ ~. /
Work Order # /,/ }.J<6 -07J
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
'Work Order No J LJ;l7cg - 073
ICreW]/7. 7)3) I/'A<-v
. /
J
DATE REPORTED J /-/-,oy
CONDITION E.lv1ERGENCY 0 ROUTINE)i{ CITIZEN CO.MPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR, 1/-/- 0 '-I TI1v1E / I. 3 t/
REP AIR LOCATION ADDRESS b ~ D ~ I J r"
~.M. DP,M.
TYPE OF MAIN .
DEPTII OF MAIN 3 '-
c. j; SIZE OJ. "
--::;>\
CLOSEST VALVE DEPTII. ~
CO.MPONENT REP AlRED.
MAIN JOINT 0 Crn.. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLA.MP 0 01HER
SERVICE TAP 0 CORP STOP 0 PIPE)( CURB STOP 0 FITTING 0
:METER SETTER 0 :METER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
CO.MPONENTSOFREPAIR. CLA.MPO DRESSERO OTHER PE ~/j)e . n?~I-~/ 5(()/J
,. I I
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA X SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRlVEW A Y CUT _IT
MAIN CONDITION INTERNAL LINING ./J,/' /l TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM
M.TO
M.
FROM
M. TO
M.
APP.A.RENT CAUSE OF LEAK.
61 rJ f,/J ~
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