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RECEIVED
SEP 2 01989
PUBLIC WORKS PERMIT '.r.it .0.
~ORKS I-a.t. fU.
lUlled ENGINEE G Application Date Cf V~f
'er.l ~ .Iplr.a Inl .
APPLICATION - AppUeot1on h herebr Mde for a ,~ric~ uJ;er.it in accordance _itll CallfDel1
RlInlclpal Code, section 11.0..
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Ut 11 it r tr.neh loc:ot1on 4JJ;;.llAt:1. _.:E _~
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C. Atteeh five (~t eopi.. ot a drawing .howlng tile locatlon, eltent and dl..n.lona of tile work
The drawlng ....ll ahow tile r.lation of the propeaed work to ..Xlating allrfae. .nd undergrollnd
189rove..nta. Mhen approved br tbe CiC~ Engineer, aald drawing Deco... a part ot thi. per.it.
P. The General Condition. for all per.itl are 1iatld on tile revera. aid.. 'pecia1 'rovillona for
thi. per.it are li.ted below. tal1llre to abid, by theae condition. and provi.ion. Mr realllt
in 10b .hut-down and/or torfeiture of ralthllll .ertoraanee aond. and ca.h depe'lt.. 5.e
General Condltlon. I and 21.
CITY or CAMPBELL '
DEPT. or PUMLIC NORI'
'0 North 'irlt 'to
ca'Pb.IIL CA .~OO.
(tOil .. -2aO
f 9-- ::23/
E. An application te. ~.t aceoapany Cbi. application. Thi. 1. non-retllndable.
::.:: 7;~C;',r~~;t: ~~ iJ:':1': u
ia thia work being don. by tbe property owner at their own reddened _'Ie. ..Lao
Tel..pllon..: 27'1~ 7847
9.rz:u
Coapl.te .ttached Worker.' Ccapen.ation and Contractor for...
The Appllcant/Per.ittee hereDy 19ree. by afli&1n9 thoir aignatur. to thl. per.it to hold the City of
Ca.pbell, it. officer., ageot. and e.ployee. tree. .ate and har.l.a. frea anr elal. Dr de..nd for
daaage. re'lIlting trea the work covered br Chi. per.it.
The Applicant/Per.itte. hereby aCknowledge. that they bave read and under.tend botb the
baCk of thla per.it, and thft ther wall infor. Cheir contraetorlal of the inforMtlon.
ACCEPTED ~ Jr::~~ / ~//C<<tf
llca I ~
front and
IIOTES: ALL WORK iHA1.L CONFOR" WITII TilE ATTACHED, APPROVED ,1.AJCS AIID ALL APPLICAA~ CUP8ELL
STANDARD DRAWINeS AND CONDITIONS.
THE CONTRACTOR NUST RAVE THIS .ERNIT AND APPROVED '1.AJCS AND NUST KEET vIra TIlE '.V. la&PECTOI ON
TilE SITE AT LUST NO DAYS BErORE 5TAJlTINC MORk.
IIOTICE IIOST aE ,aVDi TO PU8LIC WOJIU AT L&AST 24 IIOUU NPOaE RESTAJlTIMG AllY NORI.
'PECIAL PROVISIONS
_1.
Str.er .hall not be opan cut for underground in.tallationa. "ini.lI. cut. MY be allowed
for connection. or .xploracion hole.. 'lIeh Clltl ~.t be opaclflcally approved by the
I n..~ct or .
~.ve.ent ..y be ellt for under9rOllnd in.tallation. aAd ~.t ~ r..tor.d 1. accordance with
the Vti!tly Trench a.llor.tlonS.iandard Dra"in9.
Work to be .taked by . licen.ed land Surveyor or C1Yil Engineer aDd two CZI copi.a of lhe
CUI aheeta .ent [0 the PubllC Work Dept. ~fort otartin9 "ork.
The hour. ot work are la.lted to OIIt'lde the bOllra ot 1-' .... and l-6 p.a. tor anr work
olteetlng a trottic lane.
Aff4c#€7'. DOZZ. 0 / A-J ArlI:X b€:s 16.-/'01 ~1-Sa:;/iGF-~S 7/Cr-,v c."t./ iGe3n:>1'l.4-n 0"'/
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'CaMIT "PLICATION PCE
'LAM CMECI DEPOSIT
~D rOIt rAITH'UL ,a'OIlIlAHCE
r. r. (CASHt DEPO$IT
PUMIT PCE
C.-1)
IUS.OOI
ITAMDAaD AIIOUN'I' ucun NO.
no.oo I '57}. OV Q
1$00.00 I -
ClOO' or UG. UT.) I -- --
If' or aoMD,ISOO NINI I
(7, 0' P.P. 80ND cp
US.DO IUNt f '3 It:j, OD
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1$2001
APPROVED Po. ISSUANCE
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t; NPER"IT
aev Utd 7/11
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