92-126
Pl.EASE EXPEDITE
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ern' 01' CAIIPBZU.
DZP'1'. or PUBLIC 1IORD
10 N~ r~ S~.
~.~ll, CA '5001
(.01) 111-2150
Cl-2 -/20
4
~c:ROA~ PmIMT'!'
(for worlt1nq in the
puDl1~ rl~-of-way) X-Raf. fll.
Ianed {;2L.:; fj 9,2 .J AppUc;aUon Dau
PeE1Ii~ exp 13 _. Appl1caUon expu.. in 6 _.
APPLICATION - lpplicaUon u banby ..de tor a PtSblic Wora Puai~ in accordance vith ca.pbell
MwUgpal COde, Section 11.04. (Appl1cation expu.. in 6 ~ if p.~U ~r)1 V too .;,,;
A. WOrk ~ or tftc=, 1185 & 1189. Audrey Ave.. CAmpbell
UUlity 1:nncb locaUon Audrey Ayenue
B. .ature at varJu Install utilities as indicated on attached
Pua1~ 110.
ffi2719Sl
~t.~~Qrlii~~Mt
C. A~bcb fiv. (5) c:opi_ at a clravinq .bovlnq the loca~ion, exten~ and d1aenaicma of the work
Tbe clravinq aball uov the nlation of the propoaed work to ex1a~iDq aurface aDd lUldarqround
iJlpruv__a. When apprawd by the City 1n9ineu, ..1eS cSravinq ~a a part of th1a parti~.
D. Tbe General CC1ncS1Uona for all peaia are lu~ed on the nvuwa aieSe. Spacial Proviaiona tor
thia pea,it are liated belov. Failure to abieSe by theae c:oncli~iona and proviaiona uy nault
in job uu~-down and/or forfeiture of Faithful Parfona&nce 80nda and caab liepaaUs. (S_
General CcmdJ.tiona 1 and 2).
Z. An .pplication f.. _~ acc:cmpany thJ.. applicaUon. Tbu u non-ntundable.
.... at Applicant Pacifi c Gas & [1 ectri c Co. Talepbane: 725-2042
AdcSna. 10900 N. Blaney Ave., Cupertino, CA 95014
Is thJ.s work beiDq clone by th. property owner a~ their own naicSanca7 --:t.. _DO
c:o.p1eu and .~bc:b Worken' c:oapena.tion and contra=or Inforaa~ion fo~.
Tbe Appl1cant/Pu1Li~tH bereby a9"" by affixinq their aiqnatur. to thia'peait to bold the City
of
c:a.pbell, ib otflcan, .9ena and .-ployae. tne, ..fe and barale.. f~ any cl.ia or daanc:l tor
~q.. neultinq fraa the work cavllr1ld by this peai~..
'l'b. Applicant/"l"II-!-~.e benby acknovladq.. ~.t they baY. naeS and lUIcS.nbnd bot.b the front and
back of thi _ and t th.y 11 in n thei.r =n~c=or(a) of ~e inforaation.
A'~~
Dat.
2/26/92
NO'l'ZSz ALL WORK IBALL .. WI'1'B '1'U AftACBBD, Al'PItOVZD PLAIIS AlII) ALL APPLICAIt1.I c:>>IPlZLL
S'fAIIDAltD DIWfIlfGS AND COIfDl'l'IOBI.
'1'D ~cma 110ft HAft 'ftI18 PDIIII'1' AND APPRuIBD PL&D AIID IIDI'l' lID'!' WI'fII '1'D P... DfSPZCTOR OK
'l'D Sl"l'Z H LIEU'l' 'ftIO laY. ...... I'l'ARlDG 1101I&.
NO"1'ICZ JIDft a ana 'l'O JlUBLIC WORD H LUft 2. BOmtI IIU'OD RDDIl'lDIG An WORIt.
S~CYAL PRaVYSrORB
_1.
St.net abs1l not be open eat for uncleqrcNDd insta1l.tiona. 1Un~ cuts uy be allCIWed
for ~.... or exploration bol... 8Uc:b cuts -.t be .-elficallv aaarcvad bY ~.
Yft~DP.
Pavallllt ..,. be cat for ander;round iDatallaUona UIll -.t: be n8tOncl ill ac:ccmIance vi th
the UUl1ty ~cb ae.tontion Sbnc:larc:l DraviDq.
Work to be staJuId by . l1~en.ed lAnd Surt'eyor or C1vil BnlJineer UIll two (2) copi_ of the
eat sbeeU HIlt to tba Publi~ Work Depurtaen~ beflar1l starti.nlr work.
Tbe boan of work an U:a1tecl to outlIicSe the boan of 7-9 .... UIll 3... p... tor any work
.ffect.iDq . tnff1a 1...
_2.
_3.
-..
_5.
'11-1 \
_""..11ft
ft~rPr Ift:)..
AImnW'P
PDKl'l' APPLICU'IOII FD
PLD CDCK DIPOIl'!
'100.00
$500.00
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(SSO.OO)
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IO.D POll FAI'1'BlC1. PDl'OJDWICE (100' 01' aG. U'f.)
CUB DUOS1'1' ($200.00) (., or ~, '100 lID)
PLD CDCK , DfSPlCTIOIf FD ('0 - S100,000 10"
S100,OOO - '500,000 ,t, '~5 ,000 andpe ", S100 lID)
API'INvEl) FOR ISSUANCE - -- p-.r7I =t
for Ci . r
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