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Persit No.
g- t - :l3S-
CITY OF CAMPBELL PUBLIC WORKS PERMIT
DEPT. OF PUBLIC WORKS lror wor~lng 1n ~n.
70 North First St. public right-of-way) X-R.f~. (ile
campbell! CA 95008 ~ /.
(408) 860-2150 Iuued /1 7//1 Application Date 9/30/%2.
Permit e& reav~n ~~ .os. e.pire. Tn a IDa.
APPLICATION - Application is hereby sade for a Public Works Per.it in'accordance with ca.Pbeli~
Municipal Code, Section 11.04.
Work addre.. or tract' 660 West Parr Ave.
SD#41G67102, SO#6724LX'50
Utility trench loc&tion
Nature of work: Abandon Service as indicated on the attac.hed sketch.
Attach five (5) copi.. of a drawing showing the loeation, o.tentand di..nsions of the work
The drawing shall .how the rGl~tion of the proposed'work to e.iatln! aurface and underground
improveaents. When approvod by the City Engineer; said drawin4 beco... a part of this per.it.
The General Conditions for all permits are listed on the reverse'aide. Special Provisions for
this permit are listed below. 'ailure to abide by these conditions, and prOvisions may result
in job shut-down andlor forfeiture of Faithful Performance Bonds and cash deposits. (See
General Condition~ 1 and 2).
E. An application fee must accompany this application. Thi~ is non-refundable.
Name of APfl1cant Pacific Gas and Electric C~mpany Teleph~ne:
0900 N. il~aney Ave.
Addres.
A.
8.
c.
D.
725-2114
the property owner at their oWn residence? ____yes no
and ContrActor for...
this persit to hold the City of
frca any el.i. or deaand for
&Hl~.
NOTES: A L WORK SHALL CONFORM WITH THB APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDAlD DRAWINGS AND CONDITIONS.
THE CCNTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SUE AT LEAST TWO .DAYS BEPORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIlL PROVISIONS
1. Street shall not be open cut for underground installations. Minimus cuts may be allowed
for connections or e.plor.tion hole.. such cuts must be specifically approved by the
~~:~:~~~r_
...L2. 'i b4tcut for underejrOund inst~H.tions and sust be restored in accordance with
the UtUity''l'rii\ch RestoraUonStandAlrdDr,wlnq.
3. Work to be staked by a licensed Land Su~.yor or Civil Engineer and two (2) copies of the
cut .heets sent to the PUblic WOrk Dept.'beforestartinq work.
4. The hours of work are limited .o'outalde the hours of 7-9 .... and 3-6 p... for any work
- affectinq a traffic lane. '
.....::::::.5.~ /7Fc,~Lf: "77't~NC~ ~ A'TI'F11:..H-~ 7'JE:7"7fi1'/'-
~) C,H 'f SEAL r-:"A.lj~~E1':. pAUFfV\.~J J"l"') M~H Ex..;'bI7',jC::.,
. .
PERMI~ APPLICATION PES
(R-1)
($35.00 )
tt
STAlIDARD
$50.00
$500.00
(100\ or ENO. EST.)
($200) (4\ OP IOND,$500 MIN)
. (7\ or r.p. IOND
$35.00 MIN)
~ -
~ r-:---A-roJ
:tor e1'
AMOUNT
$ SO.(90
$ -
$ -
$
$ 55. 0-0
RECEIPT NO.
PLAN =aECK DEPOSI'l'
BOND FOR FAITHPUL PERFORMANCE
F. P. (CASH) DEPOSIT
PERIIIT FEE
Q
~ I~~ Ire
I 17
APPROVED FOR ISSUANCE
f: PWPERMIT
Revhed 7/87
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