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CITY 0' CAMPBELL '
D[PT. 0' PU~LJC WORKS
70 ~orth '.1.1 5t.
,a.PbellL CA .~O.
UOII .. -~ao
PUBLIC ~<<S .ERMIT
'.r.tt .0.
~'LICATION - Appltc.tion i. ~reD~ "de for a
Ryn1cipel Cod.,-"ction 11....
A. Work .ddr... or tract; TRAc:r 0'130 fZI- qS( -/-!19ZE L
UtUit~ tr.nch location ~Fj. AV(
a. "tyr. of work: ~ 4'JI1A/~ .L -JlYIJIJAItI7' jIVrntLl.Ar/rJlII ~ J#IJ.VIC"E lAIo.rc
C. Att.ch five e~. copie. of . drawing .how1ng the location, 'It.nt end di..n.ion. of the work
Yhe draWing .~ll .now thl r.l.tion of the Plopo..d work to '.1.11n9 .yrl.c. and ynd.r9roynd
i~rov...nr.. Wh.n approv.d D~ the City Ine1n..r, aaid dr.win9 becoae. a part of thi. peratC.
D. ~h. Ceneral Condition. for .11 peratt. ar. liat.d on the rever.e atd.. Speci.l 'foYtaion. for
thi. per..r .r. li.r.d below. ,.tlyr. to abtd. DY the.e conditiona and proVi.ion. "r r.aylC
tn 10b ahut-down and/or torfeityre of ralthful '.rfor..nc. 80nd. and caah depo..ta. 5.e
~neral Condltlona I and 2..
c. An appl1c.t10n Ie. ~at aecoapany tbla appl1c.tion. tb!a i. non-refundabl..
.... ot _Uc_, J)^/.(<= WA'TFl COM'A~
Adduu I Z2/ ./':' BA./'r'DAA AilE J),A/ (6_ q
~
J. thi. work being don. DY tb. propert~ own.r at theic own c..ld.ncel ____rea ~ao
Coapl.t. att.ch.d Work.ra' C~n..tion .nd Contr.ctor tor...
The AppliCant/Pelllttee hefeDy .gr..a DY affiKtng the1r a'9narYf. to thi. perait to hold the City ot
Ca.pbell. 1ta otticer.. agent. .nd e.ploy..a tree, .al. .nd har.l.a. Irge any cl.i. or de..n4 for
d...~.. r"ulttne Iroe the work Cover.d by tbi. perait.
Tel.phon.: 2.71- 784-7
Cf.s-/29
The Applicant/p.l.irt.e h.reby .cknowledlea that tb.y h.ye r..d and underat.nd Doth the
~ck of thi. per.tt, .nd that tbey VIII ofor. th.ir eontractorla. of the lnfor..tion.
ACCEPTED d~ ~ 8ti~/88
~p . ,
front and
IIO'Tl:S: ALL \IIORK 5HALL CONrORJII WITH TAfE ATTACAfED, APPROVED PJ.AIlS AIID ALL AP'LICAaLE CAIlPBELL
5TAHDARD DRAWINCS AND CONDITIONS.
TilE C'OHTRACTOR flUST IIAVE THIS PERflrT AND APPROVED 'J.AIlS AND NUST UET "11'11 1'111: '.W. IIIi'ICTOR ON
TII[ 5JT[ AT LtAsT 'NO DAYS IUOU: STARTING WORIl.
IKlTICI: IIOST al C;IVtJi TO PUBLIC WOIlLS AT LL\5T 3. lIOUas UPORI: RESTARTING AllY WORK.
SPECIAL PROVISIONS
_1.
Str.er .hall not De open cut for undergrDYnd tn.tallationa. fl!ni.u. cuta ..y De allowed
tor connect10na or e.ploration holea. 'ycn Cyt. aual be .peClflcalJy approved by the
In~~clor.
'.vI.ent ..y be eyt toe und.r9rOYnd 1natallation. aAd au.t De ce.tored 1ft ,ccordanc. with
the Utility TI.nch a..tor.tion St.nd.rd Drawing.
VOlk ro be at.ked by · ltcenaed Land Surveyor or C1Yil Ingin..r aAd two e~. copt.. of the
CUI aheeta ..nl ro the PubliC Work Dept. before atarting work.
The houra of work are 11alt.d to oyr.ld. the hour. 01 7-' .... end J-' p... tor aft~ work
affecung . traffic l.ne. .
"'" 'ic_ · ~ po...,..... 13"'-><..., L T<>TA "y w i~", ~'.:zr:. C ~"'Y':T :;:
/2.~' L,jr.sA,vb ;,voSmLL c..1.4/T" ~At:I<.. /- J(Q~D F.te.G;VTr.I~€, _,'~ I .dE'
Z€ Lc,J.5T-e.U. c -n=l:>
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.CRAIT AP.LICATION 'IE
PLAN CMECK DCPOSIT
BOHD 'OR 'AITM'UL .&a'ORKANCE
C.-1)
CU!l.OO.
q
nAIIlWlD
UD.OO
noo.OO
ClOD' or INC. 1ST.)
AIIOUNT
S Sf:). 00
.
S
,
UCEI" 110.
P. ~. eCA5HI DEPOSIT
PO'UT per
CI~OO. C., 0' aoND,I!lOO "1M)
e7' or P.P. aDND
~~ IJ!l.OO RIN.
~~~
~I
I 35, eO
c:-?
~/I{<<~e
APpaOVED POI ISSUANCE
I: Np[R"IT
a.vu.d 7,.,
\"1.-
RECEIVED
AUG 221988
PUBLIC WORKS
ENGINEERING
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