95-240
an OP CAMPBELL
DEPT. OP PUBUC WORKS
'70 North First St.
CampbcD, CA 9SOCII
(a) 866-2150
ENCROACIMBNT PERMIT
(lor wodliDa witbiD the
public ript-d-way)
/0 y3 95
Permit No.
X-It.cf. file
95-240
ApplialtioD Date 1 0 / 12 / 9 5
AflpIicatioD apiJa ill 6 ....
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II . APPUCAnON - AflpIicatioD II bcftbJ .. lor. Public Worb Permit ill acllllIdaDcc widl r..."....U MUIIiI:ipII Code, SecdaD tUN. (Appliclitiaa apiIa
.= g ill 6 IDODdaI if the permit II DOt iIIued).
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~ ~ A. WOItaddresaortrKt# S/E Corner of 3rd Street and Heritage Village Way
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2'x2' cut in asphalt for main repair
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Utility treDCb Iocatiaa
C. A1tacb four (4) copia 01 aD cqiDccred drawiDi Ibowiq tbc IocatioD, alcDt _ ctiJDc<l...,.... 01 tbc wort. nc drawiDi IbaII .. tbc reIatioa 01 tbc
JkuJ-Cd wort to cxiItiDa IU!face _ UDdeIp'OUDd Implo.emeatL Whca ~ by tbc Qty P---,,-, laid drawiDi becaIDa . put 01 tbiI permit
D. All work IbaJJ CIOIlform to the Cty'1 Gcaeral CoDdittc., SCudud ec.aructioIl ProviIioaI _ SCudud ec.aructioIl Dc&IiII for Public Worb
CoaItructioa; the GeDeral Permit CoDditioallilted c-. tbc NWDe Iide; _ the Special ProviIioaI for tbiI permit, lilted below. PaiIure to abide by
tbcse coaditioal _ pnwiIioaIlDI1 rauIt ill job lbut<<Jn _lor forfeiture 01 Paithful PafOl'lllaDCt ~tiea _ ~ dcpaIitL (See GcaeraI
Permit Coaditioal1 _ 2.)
E. A ~fuDdable applicatioD fee IDUIl ~ tbiI appIicatioa.
Name of AppIicaDt San Jose Water Company
Telepboac 279-7979
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1221 South Bascom Avenue, San Jose, CA 95128
II thiI wort beiq doae by the property oner at their on 1IIidcDce?
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No
Complete aDd attach Workers' CompeuatioD aDd Coatnctor lDformatiaa fOl'lDL
Tbc ApplicutjPerminee bereby qreea by aIfimI& their lipature to tbiI permit to bold tbc Qty 01 r...,,-..u, ita cfticcn, aptl _ empIofDeI free, gfe
aDd IwtDIeII from any c:IaiIII or dcIDaDd for damapI reIUltiq from the wort covered by tbiI permit.
Tbc AppIicaDtjPermittee bereby ac:tDoMedpI that they hive read _ UDdcrIIaDd botII the froat _ back 01 tbiI permit, _ they wiD iDform tbeir
CIODtrlctOr(S) of the iDformatioD.
Jane Leinberger (EMERGENCY VERBAL)
(Applicut (permittee) print/lip
10/12/95
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NOTES: ALL WORK SHAll.. CONFORM wrI'H 1HE ATrAaJED, APPROVED PlANS AND ALL APPUCABLE CAMPBEll.. STANDARD
DRAWINGS AND CONDmON5.
nm CONI'RACTOR MUST HA VB nus PERMIT AND APPROVED PLANS AT nm SrIE AND MUST N011FY nm PUBUC WORKS
DEPAIlTMENT AT LEAST lWO DAYS BEfIORE STAIl11NG won
NonCE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOUllS BEPORE RBSTAIl11NG ANY won
SPECIAL PROVISIONS
_1.
/2.
_3.
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Street IbaJJ DOt be opeD c:ut for UDderpouDd iIIItalIatioaL MialmUID c:utllDl1 be I1Iowed for CIOIIDC:CtioaI or czpIoratioa bola. Suc:b c:utllDlIIt ~
be mecificaUv mmoved bv tbe Iamector mior to c:uttiD2. 0
hvelDeDt may be cut for UDdeIJl'OUDd iDItalIatioDl _ IDUIl be restored ill aa:ordaDce witb tbc Utility Tread! Ratomioa S&aDcIard 0nwiJI&. t;l:j
Wort to be staked by a liceased LaDet &uw,or or CYiI EqiDeer _ two (2) copia 01 the cut IMetllCDt to the Public WOIb DeputmeDt t'z:I
before Itartia& wort. n
f?AJre IIW6 a..~ iN r::~AIC-. ANIJ p~ z,." /JitLG Pi' Ac.. ~
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STANDARD
AMOUNI'
ItErPJ1IT NO.
PERMIT APPUCAnON PEE sno.OO
PLAN OIECK DEPOSIT SSOO.oo
SUREJ'Y POR PAI1HFl1L PERFORMANCE (100'J1& OP ENG. EST.)
CASH DEPOSIT (4'" OP SUIlEIY, $SOl) MIN)
PlAN OIECK .t: INSPECllON PEE (fiRSI' ~,OOO 14"';
Next $30,000.$80,000 10%; .AIDouD~te1ir ,000 7"1&, S200 miD)
APPROVED PORISSUANCE~~
for Ci EqjDeer
h:P\V PERMIT/Rev.4/94 (ICe other side)
USA phone (800) 642-2444
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TICKET NO.
~ OF CAMPBELL
FIELD ENGINEER' S DAILY REPORT
sle Cor"...--"... " 1rtJ r./...
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ITEK
CONTRACTOR: Sa,^- J&Je 4./.:1 f-op v-
DES CRI PlIOlf
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PROJECT 80. <1 ~ -- :2- '10
REPORT 80: -r
DATE: 116/f6
WEATHER: /J .
f}11/AIJ
;!!..SPEC'l'OR: I.., /A ~
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