88-121
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CITY Or CAMP~ELL
D~PT. or PUDLIC WORKS
70 North 'Ir.t at.
Campbell, CA >>~OO'
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PUbLIC WORKS PERMIT
TflJrvoYTnr~ 1 n t' ne
public ri~ht-Ot-wa~)
J uued 3 - <f" - "rd',;'
Peralr-i.plC.. In I~ aOa.
Peeait NQ.
88-121
X-k.t. tile
Appl1catlon Date 3/8/88
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APPLICATIOH - Application la hereby .ad. tor a Public WQrk. 'erait in accordance with Caa~b.ll-
Municipal COde, iectlon 11.0..
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1. Wock addr... or tract .
Utility trench lOCation
i. Nature ot work: .
430 SAM CAVA 50' w/o DILLON
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KILL & RENEW SERVICE
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Attach tive I~) COPle. ot a drawlng IhQwln~ the 10catlQn, extont and dillenllon. ot tho work
The drawing Ihall ahow the r.latlon ot the propo..d work to o.l.tlng .urtace And undergrQund
1l1lprOVelllentl. When approved by the CHy Engineer, .aid drawlnl;j becODle. a pact 'It tht. pcr.lt.
The General CondltlQn. tor all permitl are 11atad on the rev.cse aide. Special prolllalono tor
thl. permit are Hated below. "allure to ablde by theMe condit 10n. and provllaionll _y reilule
in 10b ahut-down and/or forteiture ot ra1thful PertormAnCe bond. and ca.h depollte~. Is.:c
Goneral Condition. I and 21.
E. An application fee D1UAt accompan~ thia applicatiQn. Thi. i. non-refundable.
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Name ot AppliCAnt
Addreall
San ,Tose Water Co.
Telephone:
h thia work beln';) done 'by the property owner at their Own reiiidencc? _ye. no
CQmplete attached Worker.' CompensatIon and Contractor tQra..
The Appllcant/PerUllttee hereby a9rae. b~ attlxin9 their aiqnAture to thi. permit to hold the City at
Ca.lpoell, iu; Ofticer", a'Jentll and e.lployeclI tree, ..ate and hAr..lell~ horn an~ clala or delllArld tor
d41Ilag.,. re~uitln'J t rO/ll the wack cOl/ered by thi. perll,1 t.
'J'h.: Appllc4nt/PcC8Ilttce ho:ccby aCknowlcd9O:Ii that the~ have read and undo:clt.nd both the front and
baCk ot thi.1i pCClQit .~ that they w111 intQrm their Contr.cturlli! of the InforlllAtlon.
ACCl:I'Tl:D
<<PPIlcant lreClIllttee,
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NOTI!S: ALL 'WORK SIIALL CONI'ORH WITII THt A'M'ACHED, APl'itO\ll!D PLANS AND ALL APPlICAbLt:: CAMPbELL
STANDARD DkAWINGS AND CONDITION~.
Tilt:: CONTRACTOR HUST IIA\lI:: 'flUS PERMIT AND APPROVED PLANS ANIl HUST Ht::l::T WITH THE P.W. INSI'l::CTOk ON
Tile SITt: AT Lt:AST TWO DAYS bEl-ORt: STAltTING WORK.
NOTICE HUST bE CIVt:N TO PUbLIC WORKS AT LEAST 24 HOURS bEfORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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Stro:et ahAll not be Qpen cut tor undergrQund 1n~tAIIAtiQn~. Mini~um cut. mA~ bo: alluwo:d
tor conno:ctlons or explQration hole~. Such Cut.. rnubt be apeciticollV appravtd by Cll~
III'ip"clor.
P4Ve~~r-*4~ be cut tor underground lnllt.llatlono and auot be retitored in accOrd4nc., Wlth
tho: Utllll~ Trench RCtitorAtion St.ndard Drawing.
WuCk to Ot ataked by a licenbcd LAnd Surveyor or Clvll Engineer and t~o 121 COple~ ot the
CUt ahet:ca aO:lIl to the PulJllc WOrk Dept. betore atartlng work.
The hourll ot WOCk .rc lllllitcd tQ outbide the houre ot 7-9 A.Ill. ana )-6 p.ll. tor Any woO.
Aftecting A trAttic lane.
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PERMIT APPLICATION rEK
PLAN CHECK DEPOSIT
liON!> YOU I'AITIU'UL PERI'ORHANCE
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C100' 01' ENG. EST.I
STANDAkD
AMOUNT RfCt::IPT NO.
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PLkltlT YEt:
4~200) C., 01' IiOND,~~OO HIN)
(1, 01' ".1'. bONO
1 ~L---i ~H.OO ItIN)
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APPROVED "OR lSSUANC~
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