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RECEIVED
SEP 2 01988
PUBL~ WORKS
""ILIC l<<>IlkS .EIlMY'!' M'J\I"
tlllr wllr.lnll In I:n. ENG ttll PH..
publtc ri'ht~'__a~1 -a.f. fil.
Inu.d ~ ~ AppU~Uon Date ~o?~/.ft
'.r.ln 1" _a. ..phe_ h, . .
APPLICATION - Applic.tion i. "r.br ..de tor a 'ublic Mork. '.r.it in accordanc. with Caapbell
Runtcipal Cod., Section 11....
,
A. Mork addre.. or tlact t
CITY or CAMPIELL '
DEPT. or PUBLIC ~l'
'0 North 'ar.t St.
C..PbeIIL CA ,~OO.
e.o., a.. -~ao
P,?-d3o
I.
Ufo.J.lOIo-l Av~....u_!-E- (70100)
Utilitr tr.nCh location -TWe.e;.~ Mt AE-l...- D2.. W~,.. VAne:: D,,-,
"tur. of woe'J A,17-JU 5-.,.. VAL..N e:... Box e..c;, ,0 a.'~DE- T'OrAL...)
AttaCh fiv. CSI cople. of a dr..lng ahowln, the location, ..t.nt and dl..nllon. ot tha work
~he dravlng .n.}I .how the relation of tbe propo.ad work to .11.tlng .urtac. and under,round
iaprove..ntl. Mh.n .pprov.d br the CICy In,ln..e, aaid deawin, beco... a part 01 Cht. per'lt.
~he c.n.ral Cond1tion. for all per.Jt. ara It.t.d on tbe r.v.r.. .Id.. 'peClal 'rovl.ion. for
thi. per.lt ar. ll.ted below. '.ilur. co abid. by tb... condition. and provl.lon. "r r..ult
In 10b .hut-down and/or forfeiture of Fa1thful P,rtor..nc. eond. and ca.h d.po.at.. 5..
Gener.l Condltlona 1 and ~I.
c.
O.
I. An application t.e auat .ccoapan~ thll application. Tnl. 1. non-refund.ble.
..a.. of Appl1cant ~AI-J JOSE. VJAT~ Co ~e1.pbon.: ';"79-7f:;4f,c
Addu.. 12.2..1 ~. ~s..coM Ave.. . _ ~t.J -Jos ~ ~5' 2.&
,
I. thl. work belng don. by t., propertr own.r at Ch.lr own c..id.ncel ____'a. ~ao
Coaplet. attach.d Work.r.' Coapen..tion and Contractol for... ~
thi. per.it to hold the City of
',oa anr cla1. or de..nd for
The Applic.nt/Per.ittee hereby agr... br .ffillng thelr 819~tur. to
C.,pbell. lta otticera. 8g.nt. and e.ploy... free. .ate and bar.le..
d...ge. r..ulting Iroa the work COV.t'd b~ thi. pee.it.
front and
ACCEPTED
IIOTES: ALL...au SHALL CONFORM WITII TilE ATTACHED. UPROYED ,LAIlS AIUl ALL APPLICABLE CAlU'BELL
STANDARD DRAWINCS AND CONDITIONS.
TilE CClHTItACTOR "UST IIAVE 1'1115 PER..rT AND APPROVED 'I.AJCS AND MUST UET "11'11 TIlE P.... I~'ECTOR ON
~IIE SITE AT LEAsT TWO DAYS eErOIE STARTING MOlk.
IIOfICE IIOST IE CaVEN TO PUILIC NORU AT LL\ST ~4 MOUU UPOU RESTARTrMC AllY MORI.
'PECIAL PROVISIONS
_1.
Str..t .hall not be open cut for underground In.tallatlonl. "ini.u. cut. ..y be allowed
for connectlona or .Iploration hol... Such cuta au.1 be .pecafically .pproved by the
In.~clor.
Plv'..nt ..~ be cut for underground lnatallatlon. ,Ad auat be I.ator.d In accordance with
the Utillt~ TrenCh a.ator.tion Standard Drawlng.
Work to be .taked by a Iicen.ed ~nd Surv.~or 01 CIYll lnllin.er aa4 two (21 Copta. of the
cut .h.eta ..nt to tn. PubllC Work Dept. before.tarting work.
Tne hour. 01 work ar. 11.1ted to OUt.ld. the bour. of 7-' .... and :1-' p... for any work
a".Ctlng . tr.ffic Ian..
_2.
_J.
_4.
_So
PlaNIT APPLICATION Pll
PLAN CHECa DlPOSIT
~D FOJt FAITllrUI. PD'OIlIlAHCE
P. ~. CCASIII OEPOSIT
PERMIT PEE
C.-lI
CnS.ODI
&Eel!" 110.
t<./A-~ '1'(:;7)
8TAMDAIlD
AItOUNT
, .5lJ. &0
,
,
,
.35'-00
AP'RO~ED POI I'SUANCE
$SD.DO
noo.OO
C100' or &Me. 1ST.)
CSlOO) C4' Or aoND,5S00 MINI
n, or r... IOND
U~.OO MJaII
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