88-234
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CITY OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell! CA 95008
(408) 8h-215D
PUBLIC WORKS PERMIT
'tor worKIng 1" ~n.
public right-of-way)
Permit No.
X-Ref. file
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Issued Application Date
Permit eKp~r.. ~n l~ .oa. expire. ~n G .as.
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbe11-
Municipal Code, Section 11.04.
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A.
Work addu.. or tract t 581 West Rincon Ave.
Utility trench location SDfl41G67097
Nature of work: Abandon Service as indicated on the attached sketch.
Attach five (5) copies of a drawing showing the location, extent and di.ension. of the work
The drawing shall show the relation of the proposed work to existing surface and underground
improvements. When approved by the City Engineer, said draWing becomes a part of this perMit.
The General 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 and/or forfeiture of Faithful Performance Bonds and ca.h deposita. (See
General Condition. 1 and 2).
E. An application fea must accompany this application. This is non-refundable.
Name of Ap Pacific Gas and Electric Company Telephone: 724-2114
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Address
Is this
no
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Blane
95014
done by the property owner at their own re.idence
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Complete attach Compensation and Contractor for...
The Applicant/Per ttee hereby agree. by affixing their .ignatu
Campbell, its offi rs, agent. and employee. free, .afe and h
damage. resulting fr the work covered by this permit.
The Applica hereby ac~ledge. that they hav ead and under.tand both the
back of th - s erllit, an t atAt t . " will inform their con actor (s) of the information.
wrence H. Be /1 AJ .~ September 28, 1988
It ,.C
this per.it to hold the City of
from any clai. or de..nd tor
front and
",alt.
ALL WORK SHALL CONPORM
STAND D DRAWINGS AND CONDITION
~..
THE CONTRACTOR MUST HAV! THIS PER
THE SITE AT LEAST TWO.DAYS BEPORE
AND ALL APPLICABLE CAMPBELL
INSPECTOR ON
SPECIAL
BEFORE RESTARTING ANY WORK.
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copies of the
for any work
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RECEIPT NO.
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PERMIT APPLICATION FEI
PLAN CHECK DEPOSIT
BOND FOR PAITHFUL PERFORMANCE
F. P. (CASH) DEPOSIT
PERMIT PEE
(R-I)
($35.00)
AMOUNT
$ "q-D. eo
$
$
$
$ ^ ~~.oc:.
C?
po~
11
$50.00
$500.00
(100' OF ING. EST.)
($200) (4' OF IOND,$500 MIN)
(7' or f.P. BOND
$35.00 MIN)
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APPROVED POR ISSUANCE
tor ~lltY
f: PWPERMIT
Revised 7/87
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