95-235
nTY OP 'CAMPBEll
DEPT. OF PUBUC WORKS
70 North P'mt St.
Campbell, CA ~
(Q) 866-2150
ENCROAOINENT PERMIT
(for wortiq within the
public ri&bt-:]-wIy)
J.ued '0 5/ en- t!fiJ
Permit upira ia 12 IDOL
rmitNo. 95-0736-
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C. Attaeb fOW' (4) oopics of aJI eqiaecrcd clnwiJIIlbowiD& the Iocatioa, ClllCDt ad cliaxDlioal of the wort.. The clnwiJIIlbaD Ibow die Rlatioll of tbc
propoICd wort to c.xiItiD& lUtface ad UDdeIJl'OUDd improvemeDtL Wbea apprcMd by tbc 9!Y Eapeer, aid clnwiJII bccomc:I I part of thiI permit.
D. All wort 5baIl coaform to the Cty'1 GeIlcral CclDditioas, StudIId CoaaructioIl ProviIioaI .., ~ CoaIt:NctioG Detaik for Public WOJb
CoIlItJuctioo; the Geocral Permit Coaditioal ~ 011 the ~ne side; ad the Special ~c4-"~,\>d"".,." below", . PaiIure to abide by
these cooditioal ad proviIioaI may raWt in job lhut40wn ad/or forfeiture 01 Paithful PerfOl'llWlCe ~ I ,~tL (See Geocral
Permit Cooditioal1 ad 2.) :;r __ " i. '
E. A IIOIU'Cfuodablc applicatioll fee mua IlCllXXDJ*IY tbi& appIicatioll. (" '- /' :J ~
~9~~T~ 408-725-2022
APPUCATION - AppIicatioa iI hereby made for I Public Worb Permit ill accordaDce with CampbeI1 Nuaidpal Code, Sectioa 1UM. (Applicatioa apira
ill 6 moothl if the permit iI DOt iIIued).
A. Wort addJal or tnct # -5. 3 :1u AI IV VS (IL AUE (/1l..tfJL!E:. L L
Utilitytrcach Iocatioa S /s SrANN't'.:5ID!:.- Rile /7..2' C-/O W/~~ I S Il:EiAJALK... S/vr=- !
B. Nature of wort 4'X4' &LLHot...E '--ro cur'o'FF GAs :sC/2-V(CC S.D. # 1/C-,QRO/ l
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Name of Applicant Paci fi c Gas & El ectri c Company
Address 10900 North Blaney Avenue, Cupertino, CA
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95014
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II thiI wort being dooc by the property owaer It their OWII re8dcDce?
No
Complete aDd Ittach Workers' CompeDlltioa aDd Coatractor lDformatioa fOl'lDS.
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The ApplicutjPermittee hereby agrees by atfixiD& their lipature to thiI permit to bold the Oty 01 r..~u, its ol6cers, IpIltl ad emp&o,ea free, life
ad harm1ess from any claim or demand for damap raWtiq from the wort ~ by this permit.
The ApplicantjPermittee bereby ackDowledp that they have read ad UDdeJ'ltand both the froGt aDd back of thiI permit, aDd they will inform their
COIItractOr(S) of the information. 0 /
Accepted ~L Vir QAJ--IjJiJ n~ !/',li/i;41r:' 9-c?, 1- 7":S
(Applicant (permittee) print/sign
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NOTES: All. WORK SHALL CONFORM WIlH TIm AlTACHED, APPROVED PLANS AND All. APPUCABLE CAMPBell STANDARD
DRAWINGS AND CONDmONS.
TIm CONTRAcroR MUST HAVE nus PERMIT AND APPROVED PLANS AT TIm srre AND MUST N01lPY TIm PUBUC WORKS
DEPARTMENr AT LEAST lWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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CUT-OEF SERVICE AT MAIN
~ .::Ju AJN'f SID! Aclt::
nATt.
ADDRESS
C/O BY
JOB NO. GCfI<1ol
10 q t:X:::J
s.o. NQ.
FOOTAGE
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