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PUblIC WORI(S PERMIT Peealt No. M~ t9.1
~~rKln9 tn'~~1
public 'l~ht-ot-way) X-k.t. tile ~-{44-
luued J.f2../,pl'8<i? Appllcatlon O.te 7~~-nP,
p.'.lr lr.. In 1~ ao.. ..pire. lW I ..
APPLICATION - Appllcatlon la hereby .ed. for a PUbllc Work. '.'.It ln accordance wlth Ca~pb.ll
Municlpal COde, Il.ctlon 11.04.
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CITY 0' CAMPUtLL
D~PT. or PUbLIC WORKS
70 Noeth 11r.l it.
Campbell, CA >>~OO.
(40b I Uh-H ~O
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1. Work addr... or tract .
921 - 931 Hazel Ave.
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Ut ilhy tunch locat ion SDf/41G16945., GMf.l420780D
I 11 utilities as indicated on the attached sketch.
Nature ot work; , nsta
Attach tlve (~I copt.. ot a drawlng .howlni the locatlon, a.tant and dl.en.lon. ot the work
The drawlng ahall .how the ralation ot the propo..d work to e.l.tlng .urlace and underground
LDlprol/ement.. When epprol/ed b~ the City Englneer, .Aid drawln9 become. a pUt ot thla per.l t.
The General Condltiona tor all permlt. arc ll.ted on the rel/.rse .1de. Speclal Prol/l.lons tor
thl. per~lt are ll.ted below. tol1ure to ablde by the.e condltlon. and peol/t.lon. aoy re~ult
ln 10b .hut-do~n and/or torlelture ot 'elthtul PertormAnce bond. and ca.h depo.lt~. I~~e
Goneral Condition. 1 and 21.
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E. An application t.e muat accompany this appllcatlon. Thl. 1. non-retundable.
Name ot AppliCAnt Pacific Gas and Electric Company Tdcphone: 973-8930
AcJdccliII 10900 N. Blaney Ave. Cupertino 95014
y
1. thi. wock belng done'by the property owner at theie own r..Ldence1 ___y.. no
Compl.te attach.d Wocker.' COlI&penuation and Contractor tor...
The Appllcant/Pcr~lttee hereby agr... by attixing their .1qnaturc to thlo permit to hold the City ot
Ca.npoell, 1t~ offlce'Io, aqcntll end elllploye.. teee, ..ate and hAr.lelu. teOIll any clal'" or demAfld tor
OAIIlOg". rc~u1tl trolll the work cOl/er.d by thl. per/lllt.
O'jeli that they have reod and under.cond both the tront and
intocm thele cootractoC(til ot the lnt~6ma~10~d
July L' , 19~o
tlTe
NOT~S; LL'WOHK SIlALL CONI'OltH WITH
STANDARO OkAWINGS AND CONDITION~.
Tilt: CONTltACTOR HUST Il^V~ 'fillS PLltMIT AND APPROVED PLANS ANO HUST HEET WITH THE P.W. INSPI::CTOk ON
Tilt: SITE AT Lt:AST TWO DAYS 1lt:J'ORt: STAltTING WORK.
APPltOV~D PLANS AND ALL APPLICAbL~ CAHPIlELL
NOTICE MUST bE GIVt:N TO PUIlLIC WORKS AT LEAST 24 HOUkS bEfORE RESTARTING ANY WORK.
S~ECl^L PROVISIONS
.-,
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Str~et IohAIl not be open cut tor underground lntit41lation~. MlnL~um cut. 1I&4Y be .llo~ed
tor connectlons or exploratlon hole~. Such CUl~ muul be ~pecltlcolly 4pproved by th~
IUlipcclur.
paVeme~.4Y be cut tor under9round lnutallationa And ~ual be reutored ln Accordallce With
the Utlllly Trench Rebtoraclon StAndard DrAwing.
Wurk to Oe ulaked by a 11cenloed Land Surl/eyor 01 Cl1/11 Englneer and two 121 coples ot the
cut .heef~ uelll to the PubliC Work Oept. before atartlng work.
The hour. of WOCk ACe lUlited to outblde the houra ot 1-!j a.lll. and )-il p.lI. tor An~ woo.
Attectin9DtrAt.tlc.lan.. " .
(J:::l ("KAt Tn Of':'" c..L.t..-,-- -r' Ii':: IN (!D CRtrI~ Al..IE.
(2) OKA<j TO 'fEN c.u:r jo ;AlT" -re.E:NC.f-( e. .sm. 3+05
(3) c)'{ A"f"T""b t:f>€"-' (..~ T {~It .sf!!Jtv/~ €. STA. 2......72.
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PERMIT APPLICATION rEK
PLAN CHECK DEPOSIT
bONO 1'0k I'AITIII'UL PERI'OIUtANCE
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AMOUNT
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$
$ .3S.00
RECEIPT NO.
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(100' 01' ~NG. ~6T.1
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f. P. (CASUI OtPOSIT
PERMIT I'EE
($2001 (4' 01' bOND,$~OO MINI
0' or f.P. bONO
:-" ~. L/Jp ~)~OO MINI
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APPROVED I'OR ISSUANCE
t: PWP~ltHIT
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