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CITY 01' CAMPBELL
OBPT. 01' PUBLIC WOIUtS
70 .ortb First St.
C..pbell, CA '5008
(408) 8U-2UO
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Pel'llit No.
X-Ref. file ~~-r ~ \ +4-
Applioation oat. '5l-~ - 5?5?
Applioation expires n 6 .os.
APP~CATIO. - Applioation is b.r.by .ad. for a Publio Works P.rait in acoordano. witb C..pb.ll
KUDioipal Cod., S.ction 11.04. (Application expir.s in 6 .ontbs if p.rait not pull.d)
A. Work address or traot. ffacf cf Iso /q 2/ I q 3 I 1-( A L:..e:. L.
/
utility tr.Dob 10catioD
B. .atur. of worlu \==-0 t2. ~ 1T")t2.-t-4. l.:::i":?hi U <S.~tEH <3k )L '-{
C. Attacb five (5) oopies of . drawing sbowing tbe 10c.tioD, extent .nd di.ensions of tbe work
Tb. drawing sball sbow tb. relation of tb. propos.d work to .xisting surface aDd UDd.rqroUDd
iaprov...nts. WbeD approved by tb. City EDgiDeer, s.id drawing beooa.s a part of tbis perait.
D. Tb. Gener.l ConditioDs for all peraits are list.d OD the r.v.rs. sid.. 8p.oial provisions for
this p.rait are list.d b.low. Failur. to abide by tb.s. conditioDS and provisions .ay r.sult
in job sbut-down and/or forf.iture of Faithful P.rforaanoe Bonds and oash d.posits. (8..
G.n.ral CODditioDs 1 and 2).
B. AD applioation
.... of Applioant
DC" /:/
Addr... / / IOe>
Tel.phoD.:
tio~ This is Don-refUDdable.
JI1C
337///7
Is this work b.iDg don. by th. prop.rty owner at their own resid.Do., ___Y.S ___DO
Co.pl.te and attaoh Workers' Co.p.nsatioD and CODtraotor IDforaatioD foraa.
The Applioant/P.raitte. b.r.by agre.s by affixing tbeir signature to tbis p.rait to bold tbe City
of
C..pb.ll, its offio.rs, ag.Dts and ..ploy..s fr.., saf. and haraless fro. any olai. or d..and for
d...ges r.sultiDg fro. tbe work oovered by tbis pel'llit.
ACCEPTBD
.0kDowl.dg.s tbat th.y bave read and UDd.rstaDd both t
.y will iDfora th.ir oODtraotor(s) of tb. inforaatio
(Q
\
and
Oat.
IIO'1'B81 ALL WOU 8BALL CO WIT. 'l'BB A'l"l'ACBBD, APPROVED PLUl8 AND ALL UPLI
S'1'UOARD DRAWINGS AND ooIlOITIONS.
'1'8B ooll'l'RAC'l'OR KU8'1' BAVE '1'818 PERKI'1' AND APPROVED PLUl8 AND MU8T DE'1' WI'1'8 'l'BB P.W. I.8PEC'l'OR ON
'I'D 81'1'. A'1' LEU'1' no DAYS BEI'ORB 8TARTI.G WOU.
)IO'1'ICB XUS'1' BB GIVE. TO PUBLIC WOIUtS A'1' LEU'1' U BOURS B.I'ORB RB8TARTING ANY WOU.
8PBCIAL PROVI8ION8
_1.
.str.et sb.ll not be op.n out for UDderqroUDd inst.llations. KiDi.ua outs .ay be allowed
for oonneotion. or exploration bole.. 8uob out. .ust be specificallY approv.d by th.
Insp.ctor.
Pav..ent ..y be out for UDderqroUDd install.tion. and .ust be r.stored in aocordanoe witb
tb. Utility Trenob a.storation 8tandard Drawing.
Work to be .tak.d by a licens.d L&Dd surv.yor or Civil .DgiDe.r and two (2) oopies of tb.
cut sb.ets .ent to tbe Publio Work oeptartaent before starting work.
'1'be bours of work are liaited to out.ide tbe bours of 7-' .... and 3-6 p... for any work
.ffeoting . tr.ffio lane.
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PERKI'1' APPLICATIO. FB.
PLUI CRICK DBP08IT
(R-11
(fu.oo)
f
f
f
f
f
8TANDARD
AKOUH'l'
RBCBIPT NO.
fSO.OO
tsOO.OO
(100' 01' "G. B8T.)
(4' 01' BOlIO, f500 KIN)
BOND FOR FAI'l'BI'UL PBRI'ORKUCB
CASH DBP08I'1'
(fZOO.OO)
PLUI COCK' I.8P'C'1'ION I'EB . ~ (7~1' I'.P.
1(1 ./ /
APPROVED FOR I88UUCE ;::p;z; In,'' <::.,' <-----
fo C ty q Deer
fa PWPERKIT
Revhed 8/88
BOlIO, fU IIIN)
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