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CITY 0' CAMPBELL ~
DEPT. 0' 'UBLIC ~K'
'0 North 'il.t St.
Ca.pbell, CA .~OO.
e.o'l '..-2HtO
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PUBLIC ~KS .ERMIT
ttor worllng In ~n.
pubU~ rithC~'_a~ I-let. fil. '.
h.ud 8: ~i ef 8 AppUc:aUon Dau y-(~ -:1- / ~ R
'erai~'" . (& .~ _. ..pirea I.' I.
.u'LICATIOH - Application h "'reDl ..de for a 'uUc Ilona 'erait in acco,rdance with Ca~l1
Runici,.l Code, Sectlon 11....
A. ~ork addre.. or tract'. ~'t~
'eeait .0.
E, HAMIL.TON
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Utilitl tr.nch location
I. "ture of work: 'NSTALL I - "I'I' F. REo SE'~VlCE
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Attach five C~) cople. ot a drawlng ahowl", the loc.tlon, ..t.nt .nddl..n~lon. .ftba work
The Orawln9 ....11 .bow tlM relatlon ot the propolld work to elut1Ji9,u~'aCl and underCjlround
~aprove..nt.. Mh.n approved Dr tha C1tl IAtinaar. a.lO drawlng beeo... a plrt ot thl. perait.
Tbe General Conditlon. for all peraJt. are 11.t.d on the rever.e .ide. 'peCi.l 'rovi.ion. for
thi. perait are 11.ted below. tallure to ablde by the.e condition. and provl.ion. ..y r..ult
in job .hut-down and/or torteiture of 'aathful '.rtoreance .ond. .nd c..h depo'it.. 1$..
Gener.l Condition. I .nd 21.
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An appllc.tlon tee ....t accoapany
SAN .JoSE.
S. BASCOM
tbi. application. 7bl.
WATEfZ- CO.
AVE
1. nan-refund.ble.
'fe1ephone: 2.7<]-1847
.... ot Appllcant
Add".. -' 2..21
la thl. vork being done by tae property owner at tbe1r own r..idencel ___yea ~.o
Coapl.te .ttached ~orler.' Caapen.ation aAd Contractor foraa.
The Applicant/Per.ittee hereby a9ree. by attillng thelr .JgRAture to thl. pe~ait to hold Che Clty
C..Pbell. lta otflcer., agent. .nd ..ployae. tr... .ale and bar.le.. froa any clal. or 4eaand tor
d.aaiea re.ulting troa the vorl Cover.d by thi. peralt.
The Applic.nt/Peraittee hereby aCknowledg.. that thel ha.e read and under.tand bo(h ta. front and
Deck of thl. per.it. and that thel wlll iDfora thair contractorl.) of the inforaac'lon.
ACCEPTED ~ ~ 8'(,1.-&'
p.l. ,
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IIOTtS: ALL WORK SHALL CONrOlUl ~ITH TIfE AT'fACIIED, .uPROVED 'LANS AIID AU. AP'LICABLE CAlU'BEI.L
5TAHDARD DRAWINCS AND CONDITIONS.
TilE CONTRACTOR "UST RAVE 'flUS 'ERMIT AND "'PROVED 'LANS AND RUST UET ~I'fII 'filE '.W. IIUiPECTQIl OH
TilE 51TE AT LEAST TWO DAYS aErORE STARTING WORK.
IIOTICE IIOST aE CaVEN TO PUaLIC WOlllUi AT LEAST ~. IIOUU UPOaE aESTARTING AllY WORK.
'PECIAL PROVISIONS
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'tre.t .h.II not be open cut tor underground in.t.ll.tion.. "iniau. cut. aaybe allowed
tor connection. or elploratlon bole.. 'U~h cut. ...., be .peClfically,~pprov.d by the
In"Pf'ctor.
..vt.tnr aay be cut for underground in.tallatioRa .Ad ....r be r..tor.O lnaecordance Wlth
Che Utility TrenCh a"lor'lian St.ndard Dr.w1ng.
~ork ro ~ .tak.d by a lic.n.ed Land 6urveyor or Civil Engin.er aDd two 121 copi.. at the
cut .he.t. .ent to the PubliC ~ou Dept. betoreet.rting ,",ork..I2.AI'1.I9<VJ)/4.A.M.
The houn or ,",Ork an halted to OUtl1d. the hOur. of" - . _' tor anl WOrk
affecling a tratfic lan..
A) USE /V1ETHe.1> A o,c 7J..I€ -47T-4u-/tED U.77G':""y 7~~~CJ4/ /CF.s7nA."'177'~ ./~H'f"L
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'ERMIT AP'LICATION 'EE
rLAM CIIECK DEP051T
ca-1)
cn~.OO)
<<6)
ftANDUD
no.oo
'~OO.Oo
UOO' or DC. 1ST.)
AIIOUNT
f .so. 00
1
1
1
RECEIPT NO.
IOHD 'OR 'AITHrUL .&a'ORNANCE
,. r. ICASH) DEP05JT
rERMIT 'EE
C1200) C., 0' IOMD,i~OO "1M)
(1, or r.'. IklHD
~~ "'.00.'.'
f .35.00
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.uPROVED '01 ISSUANCE
t; PWPERMIT
a.vuad "I'
1',1.0
RECEIVED
AUG 221988
PUBLIC WORKS
FNGINEERlNG