88-142
""'CT"Qq'tl "ll
OOIt:T'11t1t
g~ltg~'1
-.- .....::s~cn
1t::JQ."1t
'" :l .0 0
~"j:;IIl..."
N.....,.......
,.:" ~ ~ ~ ::J g
~Q. ...0
~ "'O"~
~:T::l It N
II Q. lit < ~
'1 CD Ill....,
II::J>~
o rt ..... ..... 0
>-i::l.....Q....
~ .. """ t1
o ..."...."
~ 0 O:T
rDC:.-l1ftt
rttnnc:
>...lIlltC')
Z 0>><0
O'tl::J'-'O<
:T III ..
0::l:T<'1
; Ii t ~ il
.. CT .....
.. CT 0 ::l
'1 .. ::J "
.. lit
""'::J 0
>-i ~ 0
"'::l::lQ.
no" CD
~"...
CD........"
"... :T
...c:...
ZCD::JlIt
OQ.Q.
. CD
'-'111'1
::J ,
:TQ.
III
lit
V> t::">j III >-i
n ... 0 ::J '1
1l><'1Q.1t
" .... ::J
ftt In 11.... n
"'''llllt:T
o 0 CD
....::JE1~~
00....,...
III .... n CD
..... ...."
:::;O'g~'<
OQ. l"":T
'1 ~ Pt.... III
j lit >< Pt lit
~'nntj
>> '1 III ::J
.... < .: 0
I>> III ... "
n......rtrt
. CD:TCT
l "'. CD
CD "..
... ...... n :r::l
) III 0 ...
) r1' ::s 1ft n
) .... " :T
o I>> 'tl CD
::J n CD n
H'"!Jir
Q.
Cl .'Y OP CAMPBdt! C E , V II! D PUBLIC WORKS PERMIT Per.it No. cf 0 - / Y :2...
DE~r. OF PUBLIC WORKS ~ (tor worKIng In ~ne
70 North First ~~br"\ public right-o~- ay) X-Ref. fUe ~ I-L.~
Campbell CA 9~Ti\ 2 8198 ~- , (} r
(408) 866-2150 8 IpSeSUrlDedi~ ~ ~ <61~ J.': Applicat ion Date 1./-,;2. cf' - cP c:f
.os. expires In Q mos.
APPLICATION - AeLY3~~i~~ere.bY lIade for a Public Works Permit in accordance with Campbell-
MuniCipal code,~e,NfEktm:. 4ft)
A. Work address or tract' Darrl Drive &- Cail DLLve
8
o
to
tr:I
n
o
:.s:
'0
t"'
tr:I
8
tr:I
o
to
><:
B.
Utility trench location
SDII41G16860
Install utilities as indicated on the attached sketch.
Nature of work:
C.
Attach five (5) copies of a drawing showing the location, extent and di.ensiona of the work
The drawing shall show the relation of the proposed work to eXisting surface and underground
improvementa. When approved by the City Engineer, said drawing become. a part of this permit.
The General Condition. 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 Paithful Performance Bonds and cash deposits. (See
General Conditions 1 and 2).
8
::r:
tr:I
D.
;po
'0
"0
l'
H
n
;po
z
8
E.
An application
Applicant
10900 N.
fee must accompany
Pacific Gas and
Blaney Avenue
this application. This is non-refundable.
Electric Company Telephone:
725-2114
Name of
Address
1. this
the property owner at their own r..idence? ___yea
Compensation and Contractor for...
no
of
front and
NOTES: ALL WORK SHALL CONPORM W 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
~~ 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
Inspector.
_____2. ~.vemenc..y 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.
8
o
to
tr:I
n
o
3:
'0
L'
tI:l
..,
t'J
o
to
><:
8
::r:
tr:I
PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
(R-I)
($35.00)
n
H
8
><:
STANDARD
$50.00
$500.00
AMOUNT
$ ~'J. CD
$
$
$
RECEIPT NO.
q
BOND POR PAITHPUL PERPORMANCE (100' OP !NG. EST.)
P. P. (CASH) DEPOSIT ($200) (4' OP BOND,$500 MIN)
PERMIT PEE (7' OP P.P. BOND
APPROVED POR ISSUANCE ~~.
..i~t .'T'- ._~
@
f~
$ ~s:. au
'f
.-:::; - 4- - ?t~
ua
f: PWPERMIT
Revised 7/87