92-142
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70 Horth r1ra~ S~.
ca.pbell, Cl taOol
(~O') 116-2150
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ApplicaUcm Dab 4 -I' - 9 d-
Application apina in 6 _.
(z:or work1.n9 1Il CD.
public riCJbt-of....')
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APPLICA'nOH - Application 18 banby ..d. for . 1'IIb11c WOI:b PeJ:a1t in aoaozdaDaa with CUpball
MUnicipal COda, section 11.0~. (ApplicaUon azpina in 6 ...at.bII U panit not: pulled)
A. Work .ddna. or tract. RR f 120. 146. 180 191 Dillon Avenue
utility trancb location various
B. N.tun ot worka Repair sanitary sewer laterals and cleanouts
c. Attach tiv. (5) copi.. ot . drawinv aIlowiD9 th. locaUon, aftent aDd cU.un.ioa ot th. work
Tha dZ'.win9 ahall allow the nl.tion ot tha propo'" work m ax1atinCJ aurt.ca and undarqround
iaprov_anu. Ifban .pproved by tha City Bn9!near, ..id drawin9 be~ a part ot thi8 perait.
D. Tha Canard Condition. tor all permib an li.bd on the ravan. .id.. Special ProYi8ione tor
thi. permit ara li.~ed belovo Failure to abide by t.bue conditione and provi.lon. aay r..ult
in jOb .hl.lt-down and/or torfeiture ot r.it.btul Pertonanca Bcmda aDd caah dapoeita. (Saa
Can.ral Conditione 1 and 2).
B. An application fea _t .ccaapany thi8 .pplication. '1'!Ua 18 non-ntaDdabla.
Hua ot Applicant West Valley Sanita'tion :?:1_strict 'hlapbonaa378-2407
Addre.. 100 E. Sunnyoaks Avenue, Campbell
I. thia work bein9 dona by the property owner .t th.ir own ruldenaa? -Y" XXXftD
coaplete and a~tach Worur.' CoIIpena.tion and contractor Intonation fona.
The Applicant/Permitte. hereby .qree. by .ft1xinq their .1CJn&ture m thi. permit to bold the City at
campbell, it. Officer., agenu .nd employe.. tn., ..te and baral... troa any cl.ia or daaand tor
da"ge. re.l.lltin9 troa the work cov.red by thi. perait.
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The Applicant/Permitte. hereby acknovledge. ~t they bave read and underatand both the tront and
back of th1. pere1t, .nd that they vll 1nf~ the ntracmr(.) of tbe inforaat1on.
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ACC!:P'l'ED
4/7/92
Date
Mike Fuller
App11cant (Para1tt..)
HOTESa ALL WORK SHALL COHFORK WITH '!'lIB A'1"1'ACBBD, APPROVBD PLAlfS AIm ALL APPLICABLI CAKPBBLL
STANDARD DRAWINGS AND CONDITIONS.
Rt:t:~IVL,o"
THE CONTRACTOR MOST HAVE 'l'BIS PERllIT AND APPROVED PLUS AlID 1lU8'1' Dft 1fI'1'B '!'lIB P.W. Iftllkc:l1'a1T o\f
'!'HE SITE AT LEAST '1'If0 DAYS BZroU STARTING wou. 8 1992
NOTIC!: MUST U GIVD 'l'O PUBLIC WORD AT LU.8'1' 2~ IIOUlUI BD'OD D8'1'AIl'fDfG AllY .lJ?R
SPECIAL PROVISIOJfS Public Worka!Enginoerin~
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Stre.t ahall not be open cut tor unc1aq'raand inatall.tione. JUn1aua c:uta ..y be .llowed
tor coMectione or exploration bal... 8l1cb cute au.t: M .aacificaUv almraved bv the
In.l)e~or.
Pav..ent uy be cut tor uncI.rqround inatallatione aDd -.t be natoZ'WI in .ccordance with
the Otllity Tranch Re.toration Standard DrawinCJ.
Work to be .taked by a lican.ad Land Surveyor or Civil BneJinur aDd two (2) copi.. ot the
cut .heet. .ant to the Public Work Deptartaut beton lltartinlJ work.
The houra of work an liaited m oatalda the hoara of 7-9 .... aDd 3-' p... for any work
atte~in9 a trattic lan.. .--.., \0. ~ '"' ..-. \ _ I... t.
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PZIIIIIT APPLICUIOII I'D
.10'00
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PIM CIIBCIr: DD08I'1'
BOND l'OR nr1'BI'DL PBRl'DRIWrCB
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11500.00
(100' OP aG. BI'l'.)
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Dat.
CUB DD'OSI'1' (., OF .-0, $SOO lID)
PLAH CllBCll: 6 IHSPBC'nOll I'D ($0-$100,000 lOt,
$100,000 - $500,OOn~' '500'OO~"1t- 7tr 11.. _.
APPROVED FOR ISSOANCE ~ ___~/W fLJ/
for C1t cftn .
f: PWPERMIT CJ
Revised 4/91
----4-/07-8
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I IS a tiT" .~, Aa i~WPIVY ~ a tIlT"'JI~tl gULTAI.T tl~.
BOO~J PAGE I :SCALE I CORRECTED TO '-_ BY
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APPROVED
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City
Public Works
FOR ONSTRUCTION.
o Campbell
ermit No.-P -Itf,)/
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cntraeto, must have these plans
on the jab site during construction.
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