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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell! CA 95008
(408) 86b-2150
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PUBLIC WORKS PERMIT
(tor worK10g 10 ~ne
public right-of-way) X-Ref. file
Issued 3<<~r Application Date ~7~d=-d
Permi~ eap 1n ~~ mos. expires in m .
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell~
MuniCipal Code, Section 11.04.
Permit No.
A. Work address or tract I
3675 S. Bascom
Utility trench location
B. Nature of work: Install utilities as indicated on the attached sketch. SDlf41G66805
C.
Attach five (5) copies of a drawing showing the location, extent and dimensions of the work
The draWing shall show the relation of the proposed work to eXisting surface and underground
improvements. When approved by the City Engineer, said drawing becomes a part of this permit.
The General Conditions for all permits are listed on the reverse side. Special ProviSions for
this permit are listed below. Pailure to abide by these conditions and provisions may result
in jOb shut-down and/or forfeiture of Faithful Performance Bonds and cash deposits. (See
General Conditions 1 and 2).
D.
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E. An application fee must accompany this application.
Name of Applicant Pacific Gas and Electric
Address 10900 N. Blaney Ave. Cupertino, Ca.
This is non-refundable.
Telephone: 973-8930
95014
Is this
the property owner at their own residence? ___yes
Compensation and Contractor for.s.
no
this permit to hold the City of
from any claim or demand for
they have read and understand both the front and
contractor(s) of the information.
3-2-88
ua~e
NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO.DAYS BEPORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
~l. Street shall not be open cut for underground installations. Minimum cuts may be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
_____2. ravement .ay be cut for underground installations and must be restored in accordance with
the Utility Trench Restoration Standard Drawing.
_____3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the
cut sheets sent to the Public Work Dept. before starting work.
~4. The hours of work are limited ~ outside the hours of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic lane.
5.
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PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
(R-I)
($35.00)
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STANDARD
$50.00
$500.00
OF ING.
BOND FOR FAITHPUL PERFORMANCE
F. P. (CASH) DEPOSIT
(l00'
EST. )
AMOUNT
$ ~D.CL:I
$
$
$
RECEIPT NO.
Cf
PERMIT PEE
($200) (4' OF BOND,$500 MIN)
(7' OF F.P. BOND
~.INJ
$ "'>~ . GL.> Cf
~-~~-~?:
vat)
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APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/87
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