88-197
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CITY O~ caMPBBLL
DIPT. OF PUBLIC WORD
70 lIorth I'irst st.
campbell, CA '5008
(408) 8"-2150
PUBLIC WORKS PBRMIT
(for workinq in the
public ri ht-of-w.y)
perait 110. 88-197
X-Ref. file
Applic.tion D.te August 1, 1988
Applio.tion ezpires in , .os.
Issued
perait e
n 12 .os.
APPLICATIOII - Applio.tion is hereby ..de for . Publio Works permit in .ooordance with Caapbell
xunioip.l code, seotion 11.04. (APplio.tion expires in , .onths if perait not pulled)
A. Work .ddress or tr.ot f No. side of Fewtre11, 690 I W of Midway
Utility trenoh loc.tion
B. lI.ture of workl Water main break
C. Att.oh five (5) oopies of . dr.wing showing the loc.tion, extent and di.ensions of the work
The dr.wing sh.ll show the rel.tion of the proposed work to existing surf.ce and underground
iaprov_ents. When .pproved by the City Inqineer, s.id dr.wing becoaes . part of this perait.
D. The Gener.l Conditions for .11 peraits are listed on the reverse side. speci.l pJbvisions for
this perait are listed below. ~.ilure to abide by these oonditions and provisions .ay result
in job shut-down and/or forfeiture of I'.ithful Performance Bonds and c.sh deposit.. (See
General Conditions 1 and 2).
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I. AD .pplioation fee .uat acooapany this .pplic.tion. This is non-refundable.
lIame of Applicant San Jose Water Company If Telephone: ?7<1-7R47
Address 1221 S. Bascom Avenue, San Jose CA 95128
Is this work being done by the property owner at their own residence? ---yes ___no
coaplete and att.ch Workers' Coapens.tion and Contr.ctor Infora.tion forms.
The Applicant/Permittee hereby .grees by .ffixinq their sign.ture to this permit to hold the city of
campbell, its officers, .gents and ..ployees free, s.fe and h.rmless froa any cl.ia or demand for
dam.qes resulting froa the work covered by this permit.
The Applicant/peraittee hereby acknowledges th.t they h.ve re.d and understand both the front and
b.ck of this permit, and that they will inform their contr.ctor(s) of the information.
ACCEP'l'ED
IIOTBSI ALL WORlt SHALL COIlJ'ORM WITH TRB AT'l'ACRED, APPROVBD PLAKS AIID ALL APPLICABLB caMPBBLL
STAIIDARD DRAWIIIGS AIID CONDITIOIIS.
THE COIITRACTOR KUST RAVB THIS PBIUIIT AIID APPROVBD PLAKS AIID KUST KlBT WITH THE P.W. IIISPICTOR 011
TRB SITB AT LBAST TWO DAYS BBJ'ORB STARTIIIG WORlt.
IIOTICB HOST BI GIVBII TO PUBLIC WORD AT LBAST U HOORS BBJ'ORI RlSTARTIIIG AllY WOlUt.
SPBCIAL PROVISIOIIS
_1.
Street sh.ll not be open cut for underqround inst.ll.tions. Kini.ua cuts a.y be .llowed
for connections or ezplor.tion holes. Such cuts aust be specific.llY .pproved by the
Inspector.
pav..ent ..y be out for underqround inst.llations and .ust be restored in accordance with
the Utility Trench Restoration Stand.rd Drawinq.
Work to be staked by a licensed Land surveyor or civil Inqineer and two (2) copies of the
out sheets sent to the Public Work Deptartaent before starting work.
The hours of work .re li.ited to outside the hours of 7-' .... and 3-' p... for any work
.ffecting . tr.ffic lane.
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PIRKIT APPLlCATIOII I'll
(R-1)
($35.00)
STAllDARD
AMOOIIT
RlCllft 110.
9
$ SY>.OO
$
$
$
$ .3.5"".00
$50.00
$500.00
(100% 01' IIIG. 1ST.)
(4% O~ BOND, $500 KIll)
PLAK CRECK DBPOSIT
BOND J'OR I'AITRJ'UL PIRJ'ORKAIICI
CASH DlPOSIT
($200.00)
IrQ
5/;:: /-B'f
, Date
PIRMIT I'll
APPROVBD J'OR ISSUUCB
(n
.. )1..<.A../
Bn~ineer
01' I'.P. BOND, $35 XIII)
for City
f I PWPBItKIT