92-170
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Perait No. (9~ --/ 7{)
CITY OF CAKPBELL ENCROAdumrfto PERMrl'
DEPT. OF PUBLIC WORKS (for workJ.n9 in the
70 North Pir.t St. public d9bt-o~-vay) X-Ref. file
ca.pbell, CA '5001 / /4 '7 , I ~ la -, .')
(408) 1"-2150 I.ned &>/ / / '7 ~ Application Data f(} I I A .' _
Perait axpiru in, 12 JI08. APPlication upiru , JI08~
APPLICATION - Application la bereby ..de for a Publio Worb h:aait in accordance with CUaale~1 a,
Municipal Code, Section 11.04. (Application upir.. in I aontba it pe:aaJ.t not pulled) \; ~ ~V::J ~,~()
A. Workaddre..ortract. ~546 I-I/lC/eA./~ Avc-. (COSt-<6'52. rF).~ ~'\- ,...,r;f:..
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Utility trench location ACRoSi' lHtCleJcn Avt:"- ',' Ac~o~.s W"Ii.NVi Av<= ~. 0
B. Nature of workz S~.e.VIC.~ '\NOI2...IC...) Ale VAL~;G' WOZ-Ic::.... ~o':
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C. Attach five (5) copie. of a drawiD9 aboviD9 the location, extent end dJ.aenaiona of ~work n
TIle dravin9 .ball abow the ralation of the propo.ed work to exlatiD9 .urfaca and unda~ i
baprov_enta. When approved by the City Bnqlneer, ..id drawin9 becoae. a part of thla pa:aalt. 'tl
D. The eenaral Condition. for all pa:aaita ara li.ted on the revaraa aide. Spacial Proviaiona for &;
thi. permit are li.tad balov. Pailure to abide by the.e conditiona and provi.ion. ..y ra.ult Jo3
in job .but-dovn and/or forfeiture of Paithful Parfo:aaanca Icmda end oaab depa.ita. (8U till
General conditiona 1 and 2). 0
B. An application faa au.t accaapany thla application. 'l'hia 18 ncm-ratuDdabla.
Nue of Applicant ~,..J ...JC>=~&- WP<TE:lZ. <:::::...0."'---\ PA.I-...Jy 'relapbonez 1- ~ -i847
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TIle Applicant/Permittee bareby agree. by affixing thair .ignatura to thi. permit to bold the City of
Campbell, it. Officer., agent. and ~loyea. frea, ..fe and ba:aal... froa any claia or daaand for
damage. re.ultin9 fraa the work covered by thi. permit.
I. thb work being done by the proparty ownar at thair own raddanca? -ye.
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CaapI ate and attach WorJtar.' c:oapen.atlon end COntractor Infonation fona.
Tbe Applicant/Permittee bereby acknowledge. that they bave read and under.tand both the front and
back of thb permit, and that the~ will inform e r contra~~ of the lnfo~t}on.
ACCEPTED , t-J L M r...W ,e, ~f-J6e .sUPEev/<;o/Z.. ' 51.!- "/ / c;2-
Applicant ( raittee) print/alga Data
NO'l'ESz ALL WORK SHALL CONFORM WI'1'll 'l'HB A'l'TACllBD, APPROVBD PrAHS AND ALL APPLICABLB CAKPBBLL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MOST HAVE 'l'HIS PERMIT AND APPROVED PrAHS AND MUST IID'1' WI'l'B 'l'HB P.W. DfSPBC'l'OR ON
'l'HE SITE AT LEAST TWO DAYS IIU'ORB STARTING WOlUt.
NOTICE MUST BB GIVBN '1'0 PUBLIC WORKS AT LBAS'l' 24 HOURS IIU'OIUl: IUl:S'l'AR'l'ING AIR 1fOR1t.
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SPECIAL PROVISIONS
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Street .ball not be open cut for undarvround lnatallationa. Kiniaua cuta ..y be alloved
for connactiona or exploration bola.. Such cuta auft be .DeclUcaliv amlroved bv the
In.Deetor.
pav..ent ..y be cut for undervround lnatallatlona end auat be rutorad in accordance with
the utility Trench Re.toration standard Drawin9.
Work to be .taked by a lican.ed Land Survayor or Civil Bnqineer and two (2) copi.. of the
cut .beet. .ant to the Public work Deptartaant before atartiD9 work.
TIle bour. of work ara lialted to outaida the houra of 7-' .... end 3-1 p... for any work
affacting a traffic lana.
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STANDARD
AMOUNT
. /OS 00
RBCEIPT NO.
Q
PJ:RIII'1' APPLICATIOB PO
fl00.00
PLAN CllBCIl: DBPOSIT
BOND lOR PAI'1'8POL PBRroRIIANcz
$500.00
(loot OP aGo BS'l'.)
(4' OP 8:lRD, $500 lID)
($0-$100,000 lot,
e 7t, $100 1IIIf)
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CASH DD'OSIT
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Date
f: PWPERMIT
Revised 4/91
SPECIAL PROVISIONS
PERMIT #92-170 - SAN JOSE WATER COMPANY
1) Services on Hacienda Avenue may be open cut.
2) Service on Walnut Drive must be bored. Install meter box
behind future back of walk.
3) Excavations which undermine curbs, gutters, and driveways must
be backfilled with sand-cement slurry and vibrated to assure
all voids are filled.
4) The driveway on the east side of Walnut Drive must be open and
accessible at all times.
f:92-170
To:
Permitq,-- \'"'lC:> File
Address: <!;~ v..Jl ~c...tE~\~
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Cruz S. Gomez c--lsr
Assistant Engineer
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CITY OF CAMPBELL
MEMORANDUM
Date: ~-~~~4-
From:
Subject: Inspection and Acceptance
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I have inspected the improvements and find them acceptable.
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