92-161
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IDfCROAcmmrr PERKrl' Perait "0. ~-?- '/0 /
(for worJtin9 in the c:-
public ri1J9ht f~~ X-Ref. file 1 / - / 7 ~
I.wed ~ ~.:L Application Date 4" ~
Perait exp in. 12 1108. Application expiru in I~ It
APPLICATIO" - Application i. bereby _de for . Publio Worb Penait in .oooEdanoe with ~.11 I if
Municipal COde, section 11.0.. (Application upir.. in IlIOntba if ~t.notpu11ed) '~/lir 01 .. ~'
A. Work addre.. or tract, \ I ~:.;l Au Dk2E..'''t' ~~.. ,,(051-67:.> fl.1/svjf-l~ 7992-
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utility trancb location Ac~~ ,.....VDf2E...y P<VE '. (000 'E../e.. \..\Ac.~ ~\lE:- I~t)o; 0
, ~v.,.
8. Kature of wort: SEe-Vi CS EX. TE:.NSIOf'.J 1 IN"':::.T~U-;'::::"'\ION /1)1
c. Attacb fiv. (5) copi.a of . dnwinIJ abovin9 the location, extent and dhenaiona of the work n
'l'be drawin9 aball abow 1:11. rel.tion of 1:11. propoaad work to exiatin9 aurf.ce and undervround 0
iaprov_ana. Whan approved by 1:I1e city Bn9ine.r, .aid drawin9 becoaea . part of 1:I1b perllit. ~
D. 'l'be General Condition. for .11 penaia are li.tad on 1:I1e rev.ra. aid.. Special Proviaiona for ~
1:I1i. permit ar. liat.d below. Failure to abide by 1:11... conditiona and provi.ion. aay r..ult ~
in job .but-dovn and/or forfeiture of Fai1:l1ful Perfonaance Bonda and cub depoait:a. (lee t'il
General conditiona 1 and 2). tj
B. An application fee auat .ccaapany 1:I1i. application. 'l'bi. 1a ncm-refulldabl..
..... of Applicant S,&N JOSE- WATE(L CONPA.~Y Tal.phon.: 2-./9 -'l?41
Addre.. 1'2..1. I .:;., &AsLOM A\JE.. S.6..N -.J OS~ CA-
Ia 1:1118 work bein9 don. by the property owner at 1:I1eir own reaidance? --Y" ~o
CI'l'Y OF CAMPBELL
DEPT. o:r PUBLIC WORltS
70 ..orth Firat st.
c..pball, Cl '5008
(.08) 8"-2150
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co.plat. and attacb Work.ra' CoIIpan.ation and COntractor Inforaation fonaa.
'l'ba Applicant/Parmitt.. b.r.by aCJr..a by aff1xinCJ 1:I1.ir .i9Datura to 1:I1ia pamit to bold 1:I1e City of
Caapbell, it. officer., a9ant. .nd .-ploy... fra., aaf. and banal... froa any alaill or daaanc1 for
da"ge. re.ultin9 froa the work covered by thi. pamit.
The Applicant/Peraittaa ber.by acltnowl.49a. that they hay. read and under.tand both the front and
back of th18 permit, and that they will infora th ir contractor( ) of 1:11. inforaation.
ACCEPTED EOWIN l, MfLLD PE, ENh SUr'E1ZvIs.oe 4/'2.'0/'71-
Applicant (Peraitt.e) print/a19D Data
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"OTES: ALL WORK SHALL COlIFORM WITH TIlE AT'l'ACBBD, APPROVJ:D PLlIfS AND ALL APPLICABLJ: CAIIPBJ:LL
STANDARD DRAWI"GS AND COIlOITIO..S.
'1'HE CON'l'RAC'l'OR MUST HA VB THIS PERMIT AND APPROVED PLlIfS AND 110ft IID'r WI'l'B 'ftIJ: P. W. IIISPBC'l'OR 0..
'1'HE SITE AT LEAST TWO DAYS BEFORJ: STAR'l'IHG MOU.
..arlCE MUST 8J: GIVEH '1'0 POBLIC WORltS AT LDS'r 2. BOURS IID'ORB RD'rAR'rDfG An 1fOR1t.
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SPECIAL PROVISIONS
_1.
str.et aball not be open cut for und.J:'9rOUDd lutallationa. llinillull cua _y be allowed
for connectiona or exploration bole.. Such cuta au.t be .D8ci~icallY aaarov.4 bv the
InllDector.
pay..ent aay be cut for undeJ:'9rOUDd lutall.tiona aDd IlUat be ~rad in aooordanca with
1:11. Utility Tranch R..toration Standard DrawinCJ.
Work to be .takad by a lican.ad Land Surveyor or civil Zn9inaar and two (2) copi.. of 1:11.
cut .beet. ..nt to 1:11. Public Work Daptarta.nt before atartin9 work.
'l'b. hour. of work ar. liaited to waid. 1:11. boura of 7-' .... aDd 3-1 p... for any work
affectin9 a traffic lan..
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8'l'ANDARD
AMOtnfT
. /05-/ 00
HCEIPT NO.
(jJ
PJ:IDII'r APPLICATION nz
'100.00
PLAIf CBBCIt DBPOSI'r
BOlIO lOR rAI'1'Bl'UL PBRl'ORIIAIICII:
'500.00
(loot or BIIG. J:ST.)
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Date