92-119
CITY or CAIIPBBU.
DZP'l'. or PUBLIC WOIUCS
70 Narth P1r8t st.
caapbell, CA 9150'-
(408) 866-Z1S0 .
PenU.t No.
92-119
2IIeRDAcmmtI'P PmIII"f'l'
(tor worJdnq wi~ tba
public riCJht-ot-vay) X-Raf. tUB
I..ued 2( , If ( ~ V Application Dat. 2/14/9 2
PeZ1lit expira. ill 12 _. . Application upira. 1J1 6 1108.
APPLICA1'%DH - Application i. hereby _d. tor a Public Wara Penait ill .ccordance with Caapbell
JlUnicip.l COde, Section 11.04. (Application upirea in 6 1IDIl1:ba it pem1t not pulled)
A. Wark .ddn.. or tract , 905 Dell Avenup. (northR i rip - 110 I west of Dell)
B.
utility traDCb location
Nature of work: Main leak repair in park strip - 5 I xlO' cut
C. Attach tive (S) copie. ot a clrawinq aIlowinq the location, extent and d1llenaiona ot the work
The ctr.winq all.ll .how the rel.tion at the propo.ed work to aiatinq aurtac:e and WUSerqround
iJlprov..entr. When approved by the City Enqineer, nid cir.vinq beCOUII a part of thia peZ1Iit.
D. The Gener.l COndition. tor all permit. an listed on the NVeree .ide. Special Provisiona tor
this permit an li.ted below. F.ilure to abide by th..e ccmclitiona and proviaiona _y ~t
in jOb ahut-down and/or torfeiture of Faithful. Performance sureti.. and C&ab depoaits. (See
Gener.l. condi tiona 1. and 2).
E. An .pplication tea lINat accClJIpany thi. application.
Nue of Applic.nt San Jose Water Company
Addre.. 1221 South Bascom Avenue,
'l'2lia fea is nan-refundable.
279-7825
Telephone:
San Jose, CA 95128
I. this work beinq done by the property owner at their own ra.ic:tenc:e? -Y" ~o
COllplete and .ttach Workera' COIIpena.tion and COntractor Infomation tOnla.
The Applic.nt/permittee hereby aqre.. by aftixinq their .iqn.ture to thi. permit to hold th. City of
CAllpb.ll, its ofticer., aq.nts and ..ploy.e. tree, ..te and harmle.. tro. any cl.im or d...nd tor
dUlaq.. ra.ultinq troll the work covered by thi. peZ'Jlit.
The Applicant/Permittee hereby acknowledqe. th.t they have re.d and underatand both the tront and
b.ck at thi. permit, and that they will intorm their contractor(.) of the iIltonlation.
ACCEP'I'ED Glennette Lawrence (emergency verbal) 2/14/92
Applicant (Permittaa) print/.iqn D.te
NOTES: ALL WORK SHAL", CONFORK WITH THE A'l"1'ACHED, APPROVED PLANS ABC ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS ABD CONDITIONS.
'1'HE CONTRACTOR MUST HAVE THIS PERMIT ABC APPROVED PLANS ON-Srrz AIfD HOST HZE't WITH '1'BE P.W.
INSPEc:TOR ON THE SITE AT LEAST TWO DAYS BEFORE STAll'l'ING WORK. Al'PLICAH'l' HOST OONTAC:'1' 'l'B! INSPECTOR
'l'O ARRANGE FIELD KEETIHG.
NOTICE HOST BE GIVEN 'l'O PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PRQVTSIONS
_1.
Street sh.ll not be opan cut tor underqround inatall.tion.. lUniawa cute llaY be allowed
ter cennection. or exploration hola.. Such cuts must be saeeirleallv 8DDroved bv the
Insneetor nrior to eu~~ina.
pav..ent -y be cut tor underqrcund inatallatiena and 1IIU8t be ra.tored in .CCOrdance with
the Utility Trench Re.ter.tion Standard Dravinq.
Wark to be at.ked by a lican.ed Land Surveyar er civil Enqineer and two (2) copt.. ot the
cut shaat. .ent to the Public Work Department betore ~tartinq work.
The hours ot work are limited to outside the houra of 7-9 .... and ]-6 p... fer any work
atfectinq a traffic lane.
_2.
_3.
_4.
_5.
S'rAHDARD
AMOUN'J'
$ 105.00
$
$
$
$ 101) nn
RECEIPT NO.
Q
PDKIT APPLICU'XON FZE
PL&N CBEot DEPOSIT
SDRETY POR rAITBFDL PERFORMANCE
CASH DEPOSI'1'
$105.00
$1500.00
(100' or BIIG. BIT.)
(4' OF SDRErf, $500 M%N)
PLAN CBEot , INSPECTION FEE. ($0-$100,000 10',
$1...... - $....:"l:. 1~.. ...~. $1.. HDJI
APPROVED FOR ISSUABCZ . ~ ~ r:l..-
or City Enqineer
Q
2-\4--9 '<-
Date
! : PW PERMIT
Revised 10/91
(SEE OTHER SIDE)
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