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~OI ~.1he Applicant/Permittee hereby agree8 by affixing their signature to thi8 permit to hold the City of
:::r~' ampbell, its officers, age t8 and employees free,.afe and harmless from any claim or demand for
OI'~ damages result' ~om ork coyered by this permit.
In . l;1he Ap licant/ itte..e he eby ~.ledgeS that they have read and understand both the front and
!~.' . r it, ~nd t at t~t~ll inform their contractor(s) of the information.
,. ACCEPTED "m'La h 3-10-88
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CCTY OP CAMPBELL
DEPT,. OF PUBLIC WORKS
70 North First St.
campbell! CA 95~D8
(408) 860-2150
Permit No.
Yr?-/2 0
MAR 1 MWAC WORKS PERMIT
5 ~worlun9 1n ~ne
public right-of-way) X-Ref. file
PUBLIC WDAI'Sed V~ffo Application Date 3 -/ .,- ~,f'""Y
ENGINEERlrf~rmi~ np 1n 1.: mos. expires 1n \) m08.
APPLICATION - Application 1s hereby .ade for a Public Works Permit in accordance with Ca~pbell-
Municipal Code, Sectio~ 11.04.
Utility trench location
Nature of work: Install utilities as indicated on the attached sketch. SD#41E97627
Attach five (5) copies of a drawing showing the location, extent and diaen8ions 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 become8 a part of this permit.
The General Conditions for all permits are listed on the reverse side. Special provi8ions for
this permit are listed below. Pailure to abide by these condition8 and provi8ions may result
in job shut-down and/or forfeiture of Paithful Performance Bonds and ca8h deposits. (See
General Conditions 1 and 2).
E. An application fee must accompany this application.
Name of Applicant Pacific Gas and Electric
Address 10900 N. Blaney Cupertino, Ca. 95014
This is non-refundable.
TelePhone:973-8930
Is this work being done by the property owner at their own residence? ___yea
no
u.~e
NOTES: ALL WORK SHALL CONPORM 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
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1. Street shall not be open cut for underground installations. Minimum cuts may be allowed
for connections or exploration holes. Such cut. must be specifically approved by the
o ~ Inspector.
~2. ~avemen~ may be cut for underground installation8 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 aent to the Public Work Dept. before starting work.
4. The hours of work are limited ~ outside the hour8 of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic lane.
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"'STArv< CJ\F- ~O~, (R-l) STANDARD AMOUNT RECEIPT NO.
PERMIT APPLICATION PEE ($35.00) $SO.OO $ ~.~ -€if
PLAN CHECK DEPOSIT $500.00 $
BOND POR PAITHPUL PERPORMANCE (100\ OP ENG. EST.) $
P. P. (CASH) DEPOSIT ($200) (4\ OP BOND,$500 MIN) $-
PERMIT PEE (7\ OP P.P. BOND
4~',
APPROVED POR ISSUANCE
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f: PWPERMIT
Revised 7/87
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