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70 North 'alat St.
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ENGINEERIN'
APPLICATION - App tion ia h.r.by ..de lor a 'Yblic Moc_. '.cait
Rynicipal Cod., S.ction 11.0..
PUBLIC WORKS .ERMIT
Hur wuulnrt"1n ,"n.
public li9ht-ol-.ay'
"aued <:;; -- ~ f - <f~,s--
'.tail ..pll n &4 .0..
I-ad. I U.
Application D.c. ~... ~ -c:PJ
..pil.... ~..
in accordance .ith Caapbe11
.. ~or_ addr... 01 tcact, [Jl~
RCL~lf\l
LANE
Utility tr.nCh locac1on
.. "lYr. of wocaz M Pi 11\1 Il\l~.,.T/\LL/\TI C N
l~ 2., .- j 2(2 \
C.
D.
Att.ch tive C"I ~opiee of a dra.ing .howing the location, eltent and di..neiona of the work
The dra~lng ahaJJ ahow the r.Jation of tbe propoa.d work to ..Iating ayrtac. and undelground
1aprove..nte. ~h.n approv.d by the City Inglneer, .aid dra.ing beco..e a part of Chl. perait.
The Ceneral Conditione tor all peralt. are lieted on the rever.e aide. lpecial 'roviaiona ror
thie perait ar~ li.ted below. 'ailure to abide by the.. condition. and provi.ion. aar reault
tn 1ub ehut-down .nd/or lorreiture of r.athful 'artoraance Bond. end caeh depoeata. 5..
General Condlllone J and 21.
E. An applicatlon tee auat eccoapany thi. application. Thl. ia non-relundable.
So A [\\ c.l L, SEW lC>... I L ReO M P A 1'J '( Telephone: '~2.. 7 OJ -7 b <1- If
S A fd de"') C \ C/='l L \ F _ 1) '5 I -'j ~
,
la thle work being done by the property owner at their own r.aidencel ___r.a ~RO
Coapl.t. attaChed ~ork.ra' Cu.penaacaon and COntractor tor...
Ma.. 01 Applicant
Adduu r:. GO' b CA c.?. 2. ""1.l
Th. AppIICant/Peraltt.e hereby a9r.e. by aftillng thell a'gnature to lhia perait to hold the Clty of
C..puell, It. ottlcera, agent. and e.ployaee tree, aale and bar.le., Iro. any clai. or de..nd fur
daaagea reaulting tro. the work covel.d by thaa peralt.
The Applicant/ r.itte. h eby aCknowledgea that they bave I.ad and under.tand boWh t front
.... of .... ,...... ... t "r ..11 '.'0'. ..." c~" mo"., of ..~~" , .
ACCEPTED #If 'tZt1t:lU-<--- ~ "7
E. NIS Il\\k: CR.I N C, !..:. c r ER \J 1'-:1',] FZ- . i'"":\ j~
and
.oTrs: ALL WORK 5HALL COHrORM WITH THE ATTACHED, APPROVED PLAMS AMD ALL AP.LICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
TilE C'OHTRACTOR MUST RAVE THTS PERMJT AND APPROVlD 'LAMS AND IIUST fUn "ITH THE P.". 1llSPECTOR ON
TilE SITE AT LUST ,.,.0 DAYS BEFORE STARTING tIORll.
IIOTICE IIOST BE CIV&H '10 PUBLIC WOIl" AT lL\5T l4 IIOUU azPOU: aESTARTINC AllY tIORl.
SPECIAL 'ROVISIONS
_1.
*~2.
_J.
_4.
~!'l.
Street ahall not be open cut for underground tnetallationa. "inlaua Cuta ..y be allowed
tor connectiona or ..ploration bolea. Such CUt. aU'1 be .peclflcally approved by the
I na;~CI or.
.av..ent ..y be cut 101 ynderground in.tallatlORa and .uat be I.ator.d 1n accoldance .lth
the Utl1ity TrenCh a..lur'liun Stand.rd Oraw1n9.
Work [0 be at.ked by a licena.d L.nd Surveyor or Cival Engin..r aDd two (~l copi.a of the
CUl aheela a.nt to the PubllC Work Dep[. b.tore .tartln9 work.
Th. hour. of work are la.ated to outaad. the Doura of 7-' .... and J-' p.a. tor any .urk
al~.ctlng a trattic Ian..
11 c..~\ P .<IEAL AL\... .pAYE'/V\~"-L-r- R.E'~R..A.-n-f;:)M.s.
t B) BDI< E' f-l L L .s~v I CE-~
.lRMIT AP.LICATION PEE
,LAN CHECK DEPOSIT
80HD 'OR rAITHFUL .&a'OIlNAHCE
ca-U
fU!'l.OOI
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ITANIWlD
no.oo
UDO.OD
flOO' or DC. 1ST.)
AItOUIIT
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,
,
, 269.50
nClI" MO.
P. ~. CCASH) DEPOSIT
'EaMI1' PEE - /~30 L..F
Cf~OOI C., OF aOND,i$OO IIIN,
- $"00 /.. .P. @ . Z 0 (1, or P.'. aONO
1/..30 L.r; e , IS .n.oo IllN,
17 ! !"1 ~ ,: ',., , / '"
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~ur ~I~. .n~&n~.(
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AP.aOVED rOIl IS5UAHCE
, II(
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8
t I "'PER"I"
a.vu.d 7/17
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