88-198
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CITY OF CAMPBELL
DBPT. OF PUBLIC WORD
'70 lIorth First St.
Caapbell, CA '5008
(408) 866-2150
PUBLIC WORD PERMIT
(for workinq in the
public riqht-of-w.y)
I..ued .~ C)...- t'8'
Permit ezpires n 12 .os.
Permit 110. 88-198
X-Ref. file
Application Date 8/1/RR
Applic.tion ezpfres In 6 .os.
APPLICATIOII - Application is hereby .ade for . Public Works permit in .ccordance witb Caapbell
Municipal Code, Section 11.04. (Application ezpires in 6 .onths if perait not pulled)
A. Work .ddress or tr.ct . West side of Dell Ave. ,10' S. of Lost LakE'! T.;:mE'!
utility trench loc.tion
B. lIature of work: Broken Water Main
C. Attach five (5) copies of a dr.winq showinq the loc.tion, eztent and diaensions of the work
The dr.winq sh.ll show the rel.tion of the proposed work to ezistinq surface and underqround
iaprov..ents. When .pproved by the City Enqineer, s.id dr.winq beco.es . p.rt of this perait.
D. The Gener.l Conditions for .11 peraits are listed on the reverse side. speci.l PJovisions for
this perait are listed below. Failure to abide by these conditions and provisions .ay result
in job shut-dOwn and/or forfeiture of Faithful Performance Bonds and cash deposita. (See
Gener.l Conditions 1 and 2).
B. AD application fee .ust accoapany this .pplic.tion. This is non-refundable.
Telephone: 279-7847
llaae of Applicant San Jose Water Companv
Address 1221 S. Bascom Avenue, San Jose, CA 95128
Is tbis work beinq done by the property owner .t their own residence? ---yes ___no
Co.plete and attach Workers' coapens.tion and contr.ctor Infora.tion foras.
The Applicant/Peraittee hereby aqrees by .ffizing their sign.ture to this permit to hold the City of
Caapbell, its Officers, .qents and ..ployees free, safe and harmless fro. any clai. or demand for
daa.qes resulting froa the work covered by this permit.
The Applicant/permittee hereby acknowledges th.t they have re.d and understand both the front and
b.ck of this permit, and that they will inform their contractor(s) of the inform.tion.
ACCEPTED
IIOTES: ALL WOU SHALL COlIFORM WIft ftB ATTACHED, APPROVED PLANS AHD ALL APPLICABLB CAMPBBLL
STAHDARD DRAWIIIGS AHD COHDITIOIIS.
ftB COHTRACTOR MUST BAVE ftIS PERMIT AHD APPROVED PLANS AHD MUST KBET WIft ftB P.W. IIISPBCTOR 011
ftB SI'1'B 70'1' LBAS'1' TWO DAYS BBFORB S'1'AR'1'IIIG WOU.
HOTICB XUST BB GIVBH TO PUBLIC WOIUt8 AT LBAST 24 HOURS BBFORE RESTARTIIIG AllY WOU.
SPBCIAL PROVISIOIIS
_1.
Street sb.ll not be open cut for underqround inst.llations. Kini.ua cuts ..y be .llowed
for connections or ezploration holes. Such cuts aust be specificallY approved by the
Inspector.
pav..ent a.y be cut for underqround inst.ll.tions and .ust be restored in .ccordance with
the utility Trench Restor.tion Standard Drawinq.
Work to be staked by . lioensed LaDd surveyor or Civil Bnqineer and two (2) copies of the
cut sheets sent to the Public Work Deptartaent before st.rtinq work.
The hours of work .re li.ited to outside the hours of 7-' .... and 3-6 p... for any work
affectinq . tr.ffic lane.
_2.
_3.
_4.
_5.
PBRMIT APPLICATIOII FBB
(R-l)
($35.00)
AKOUII'l'
RECBIPT 110.
STAHDARD
Q
$ ~.OO
$
$
$
$ .35.00
$50.00
$500.00
(100\ OF BIIG. BST.)
(4\ OF BOlIO, $500 XIII)
PLAN CHECK DBPOSIT
BOlIO FOR FAIftFUL PBRFORMAHCB
CASH DBPOSIT
($200.00)
~
PBRMIT FEB
(7\ OP P.P. BOlIO, $35 XIII)
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APPROVED POR ISSUANCB
for
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