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CITY 01 CAKPb~LL PUbLIC WOM~S '~k"IT
O~PT. or PUbLIC WOkl~ ~rrrnq-rn-ynf
'0 North lilll it.' p~bllc 'l~ht-of-~ay) X-k.t. tl1.
Ca..pb.ll, CA. '~OO. ~ ~ .v 4 11 88
hOlll lIh-H~O I .~ d </-, Z d'o A.ppliCatlon Dat. --
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APPLICATIOH - Appllcal10n la he'eby ..d. lor a P~bllc Wock. '.ralt 1n accoldanc. wlth Ca.~bell-
K~nlclpal COd., i.Cllofl 11.0t.
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Utility trench location
M. Mat~ce of ~ork:
1736 WINCHESTER (X LATIMER)
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KILL & RENEW SERVICE
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Altach tlve (~. cop'.. of a drawing ahowlng the location, ..tent an4 dl..n.loo. of the woek
Th. dU~ln9 .llaU ahow the celation ot th. plopo..d wOlk to ..'.tlng .ulhcc Alld ~ndClg(Ound
i.prove_nu. When aPPloved uy the CHy &:09in..(, add drawlng beco... a pact ot thll pee.lt.
The 'encral Condltion. tor all peralt. arc li.t.d on the rev.rae a14e. Speclal Provl.lon. tor
thl. pel.it ace 11ated below. tallule to abide by the.c conditlon. and pcovlaiona ..y Ic.~lt
in 10b ahut-down and/or forfelture 01 'althful Pertor.ance bond. an4 ca.h dcpoalta. (~ce
'ancral Condltiona 1 and ~..
E. An appl&cation lee aual acco~pany thi. appllc.tion. Thl. i>> non-r.fundable.
"aile ot AppUCant ~AN JOSE WATER CO Telephone:
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I. thi. work being dune 'by the pcopertY owner at th.lr OWO r.6ildenccl ___y.. no
Coaplele attach.d Workera' Co.pen.ation and Contractor tora..
The Appllcant/~el.lttec hereby A'll e.. by .tt&.in9 theic .i~nat~ce to lhl. pelail to IlOld lhe C1CY ot
C...p...:ll, it. ottlccla, al)ellta and elllpJoy.e. tree, ...te and haral..a Leu. eny cl.&. Ot delllAlId toe
dAlIlagt:. ce.ultln~ f 1011I the wC)ck COVel.4 by lhia PCUll t.
The A~pliCallt/Pel.ltlee heleby aCknowledl)ea that they have read and under.land both lhe Ironl and
baCk ot th~a pel.lt ana th..t they will Intor. their contracluC(.1 of the loforaatlon.
ACCt:I'Tt:D
~pr.canl \rcrllltteel
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MOTtS: ALL'WORl( SIlALL CONI'OlCK WITlt Tilt ATTACHED, APPltOVtD PLANS AND ALL APt'LICAb1.t CAKPb~L.L
STANDAkO DKAWIH~S AND COHOITIOH~.
Till: CONTlCACTOR MUST UA.Vt: TUIS Pt:kKIT AND APPROVI::D PLANS ANIJ KUST K1:t:T WITH THE P.W. IN:-If-t:CTOk ON
TUt.: SITt AT Lt.:A.ST ,'WU DAYS b~"Okt.: STAJtTIHG WOill.
"01'IC[ "U~T bt.: CIVi:N TO PUbLIC WORKS AT LEAST 2t HOURS b~rOkE R&STARTIHC ANY WORK.
S~[CIAL PROVISIONS
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SIred .IIAll oot be open c:~t for ~nderglound 1n.t_llation4O. "Ini"~11 cut. ..Y be allowed
tOI conllcctlo"~ or ..ploratlon hole~. Such cut.,; .u_t be MP~C111CA1Jy Approved by th~
lIIIiP"Clul.
P4VI~~..ay be cut foc undec9round lnMtallalion. and IIU.t be le.tO'ed in accocd4nce ~lln
lhe Utility Trench McAitolallon Standard Dr..~ing.
Wura to Uc atAked by a 11ccna;cd Land 6~lvcyor 01 Civil ~n91n.ec and twO (2) Copies of lhe
cut alleela .elll tQ lhe Public Work Dert. bcture alartlng ~Ork.
The hOUI. of ~oCl ,,'e hlliled to o~t. de the houl. 01 l-j a.ll. and J-iI p... fo, AOY ~ork
att.clln9 a cl..tflc lane.
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atOND rOk 'AITUI'UL PtkrORt\AJ'4C&
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(100' 01 ENe. ~6T.)
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($200) (t. 0' atOND,$~OO "lNI
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