88-128
- c:r "d "'tI
:0 rt ft) to
g ~ ~ ~ 1'1
.J .....:J ~ en
/II ::l !:l. n ...
'" :l .0 0
I:'n~Ul...n
...., tII ~ ft) UJ ~
~:.1 ~ ~ ::l g
I:'!:l. ...0
... ... 0 n ~
I:'::r::l'" N
/II !:l. III <: ....
....... Ill....
/II ::l )>....
On...........o
-l::l ... /II !:l. ...,
...... I-t) l'1
") ...... rt ...... I"t
'I" 0 O::r
DC:A>>-r1ft)
"'t (J) n C
>~tI)CDC)
z: 0)> X 0
) "Cl :l ~ 0 <:
::r III /II
o ::l ::r <: '1
;~:~5
u C" ,.... (tli
... 0" 0 ::l
.... /II ::l n
/II III
'" ::l n
>-I ~ 0
"'::l ::l !:l.
nOn ft)
l<'n...
..........n
n..., ::r
...c::...
Z/II::l1ll
O!:l.!:l.
. ...
'-'Ill....
::l 0
::r!:l.
III
III
UlO"lIll>-l
M't-'oO::Jl'1
III <: 1'1 !:l. ...
n..... :J
(II en ...... (]
"'''lllll::r
00...
""::l~~~
(")0"'>-1""
III ..., n ...
...... .....n
~ ~ S ~'<
O!:l. r<::r
"1Ctrl.....1ll
j III X trl III
-. n 0 0
" .... III ::l
..... <: ( 0
OJ, A3 ..... rt
/)..~nn
. ...::r 0"
:l ~. (1l
... n...
.... ...... n ::r::J
) PI 0 .....
., n :J In n
D ..... n :r
o III "Cl ...
::l 0 (1l 0
;.IIl~~~
"'!:l.
n
o
n
IECE.'
D
Per.it No.
cY ?- / 2. P
1--,3
o
CITY O~ CAMPBELL PUBLIC WORKS PERMIT
DEPT. OF PUBLIC WORK~AR 1 7 ljtj~tor worung In tne
-,10 NS;:i~ ~5itd~08 ... "PUblic right-of-wal),
R "~"'8U-2~0 PUBLIC "\SIssued 3 /3 j I .-:r 0
W......\I . Permit: ell61res/ln 1", mos.
1'MRx.B::a.18~a APPlicafft~l~f~~I~ .ade for a Public Works Permit in accordance with Campbell-
Municipal Code, Section 11.04.
PUBLIC WORKS
mGlftf~RtAtfess or tract'
Utility trench 1
X-Ref. file ~
Application Date ?~o:;/~<f" t':l
expires In g s.
B.
Nature of work:
Attach five (5) copies of a drawing ahowing the location, extent and di.ensiona of the work
The drawing ahall 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. ~ailure 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).
C.
1--,3
::r:
t':l
D.
;l:'
'U
-0
L'
H
n
;l:'
z
1--,3
E.
non-refundable.
TelePhone:...913- gq 8D
Name of
Address
Is this work being
Complete attached Workera' Compensation and Contractor for.s.
no
The Applicant/Permittee
Campbell, its officers
damag lting fr
affiXing their signature to this permit to hold the City of
eea free, safe and harmless from any claim or demand for
this permit.
t they have read and understand both the front and
their contractor(s) of the information.
3J 1 fcJj %
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 BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 BOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
1--,3
CJ
~
[TJ
'/.1.
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.
~avement may be cut for underground installations and must be restored in accordance with
the Utility Trench Restoration Standard Drawing.
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.
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. (' _ . ""-
B. ~~ ~[-~::.~t ~c.~ _ ~~,-.- (~~ c..rD~'b-=;tL:::g",->
n
o
3:
'11
L'
[TJ
rJ
[TJ
CI
OJ
><
r3
~
[TJ
2.
3.
4.
V5.
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
BOND fOR fAITHfUL PERfORMANCE
(R-l)
($35.00)
cp
n
H
r3
><
STANDARD
$50.00
$500.00
(100' OF ENG. EST.)
AMOUNT
$ ~. C:(,.".)
$
$
$
RECEIPT NO.
1fjJ!js'6
~e)
~-
F. P. (CASH) DEPOSIT
,~~ ~f'l"
PERM1T PEE
($200) (4\ OF BOND,$500 MIN)
(7\ OF F.P. BOND
~ $35.00 MIN)
~~
$ \~.q~ cp
~-~\-~~
lJat
APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/87