88-220
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RECEIVED
~~~~I~o~~~~ ~~R~~; S E P 1 IS~0it No. Po - 2 Z- ()
"""lie "Oh'-of-..y) X-Ref. fU. ~h ~
Iuued ~ 7/Jit" ~ ~:1 Works Admi4\8ltltWiat ion Date q , / <f c:f"'" n
Per.i\; pJ.te. 10" lIOS. expire. 10 . 0
3:
APPLICATION - Application is hereby .ade for a Public Works Per.it in accordance with Campbe11- ~
Municipal Code, Section 11.04. ~
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CITY OP CAMPBELL
DEPT. OP PUBLIC WORKS
70 North First St.
Campbell! CA 95008
(408) 860-2150
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A.
Work address or tract' 180-190 Harrison
Utility trench location Abandon gas service to above addresses as indicated on
B. Nature of work: the attached sketch. SD#41G67093
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C.
Attach five (5) copies of a drawing showing the location, extent and di.ensions of the work
The dr.wing shall show the relation of the proposed work to existing surface and underground
improve..nts. When approved by the City Engineer, said drawing beco... a part of this permit.
The Gener.l Conditions for all permits are listed on the reverse side. Special Provisions for
this permit are listed below. 'ailure to abide by these conditions and prOVisions may result
in jOb shut-down .nd/or forfeiture of Paithful Perfor..nce Bonds and c..h deposits. (See
General Conditions I and 2).
E. An .pp1ication fea must .ccomp.ny this .pplic.tion. This is non-refund.ble.
A 1. t Pacific Gas and Electric Company 725-2114
Name of pp lcan Telephone:
Address 10900 N. Blaney Ave. Cupertino
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Is this work being done by the property owner at their own re.idence? ___yea no
Complete attached Workers' Compensation and Contractor for...
The Applic.nt/Peraittee hereby agrees by affixing their .ignature to this per.it to hold the City of
Campbell, its officers, agents and e.ployees free, safe and harmless from .ny claim or de..nd for
damages resulti from the work covered by this permit.
The Applicant .ittee hereb edges that they have read and understand both the front and
back of this mit, and th i inform their contr.ctor(s) of the information.
~ .-- September 6, 1988
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NOTES: L WORK SHALL CONPORM WITH ACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO.DAYS BEPORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEPORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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1.
Street shall not be open cut for underground in.ta11.tions. Miniau. cuts ..y be allowed
for connections or explor.tion hole.. Such cuts must be specific.lly approved by the
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y be cut for underground installations and aust be restored in accordance with
the Utility Trench Restoration Standard Dr.wing.
Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the
cut sheets sent to the Public Work Dept. before starting work.
The hours of work are limited ~ outside the hours of 7-9 .... and 3-6 p... for any work
affecting a traffic lane.
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PERMIT APPLICATION PEl
PLAN CHECK DEPOSIT
BOND FOR PAITHPUL PERPORMANCE
P. P. (CASH) DEPOSIT
PERMIT PEE
(R-l)
($35.00)
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STANDARD
$50.00
$500.00
(100\ OP !NG. EST.)
(4\ or BOND,$500 MIN)
(7\ OP P.P. BOND
$35.00 MIN)
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($200)
AMOUNT
$ .5?:;. 00
$
$
$
RECEIPT NO.
$ .35"". DO
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APPROVED POR ISSUANCE
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f: PWPERMIT
Revised 7/87
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