95-244
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APPUCATION _ AppIicatioll is bereby made for a Public Worb PcnDit ill 8CICI)I'daDce with CampbdI NUIlidpaI Code. Sectioa 11.04. (Applicatioll apira
ill 6 moatbs if the permit . DOt iIIucd).
A. Wort addJ'CSli or trKt # --rRA-~-r? 12-' - -rt=-.MIbMJ2.rr 11-"00-
Utility treDCh Jocatioll NOfC,r!/ LJr oLLA tUJ ~ I LJ~
B. Nature of wort /,J5111LL o..~c.11tIc.. !'.Ac..IL 11T~
ENCROAOINENf PERMIT
(for worItiD& withiD the
public npl4-way)
bAe4/C -..<.5 - ~!&)w-i
Permit apira ill U IDOL j'
nrmit No.
X-Rd. file
95- c:J H
an' uF CAMPBELL
DEPT. OF PUBUC WORKS
10 North P'ust St.
Campbell, CA 9SWl
(0) 866-2150
, /) - a....,--
AppIicatioll Date Iv .- d 6 -- ~
AppIicatioll ~ ill 6 IDOL
C. Attach four (4) copies of u eoginccred cSnwin& IbowiD& the Jocatiocl. exteDt _ ~ of the worL The cSnwin& Iba11 *'" the rdatioII of the
propoiCd wort to cxi6tin& lUrlacc aDd UDdcrpouDd ~mena.. WbcD ~ by the Oty Eqincer, laid cSnwin& bccomCI a put of thi& permit.
D. All won dJal1 coaform to the City's GeDcral CoDditioal, Standard ~ I'roYiIioIlI _ Standard CoaIt:r\ICtiOI1I)ctai)1 for Public worts
(;oastructioIl; the Geocral Permit CoDditiool ~ 011 the revetse side; _ the Special J>roo,oiIiooI for thiI permit, lilted below. p.aure to Ibide by
these cooditiOlll _ prcNisioaI may result ill job sbut40wD _lor forfeiture of Paithful Perf()I'IDaDCC Sureties _ CMh depoQa.. (See Geocral
Permit Cooditiool1 aDd 2.) ~11,J K ~ () ~ 1l 'S. ZID J
E. A DOIII'Cfundab\e application fee must 8CICIOIDJlU!Y thiI application. 40K 12:5.204- 'j'
Name or Applicant Pacifi c Gas & [1 ectri c Company Tdepbooe 408-725-2022
~J'CSIi 10900 North Blaney Avenue, Cu ertino CA 9501
f CJ J IJ5 t7J L- L LLE L.:f'Jc.;1 C- I74c-/L 111 €.s
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Is thi& wort being doDe by the property owner at their OWII reaideDce?
Yes
No
OCf! 51995
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Complete and attach Workers' Compeosatioll _ Contractor Information fOl'\DL
The ApplicantfPermittee hereby agrees by aIfixin& their lipature to thiI permit to bold the Oty of c..."....-n. iU ol6ccrs, ~J.J iMd ~~~ I Afe
aDd barmlell from uy claim or demand for cSamap JUUltiDi from the wort coycred by this permit. ADMJNISTRA TION
The AppUcantfPermittee hereby ackDowledp that they have read _ understand both the frOIll _ back of this permit, _ they will illform their
COIltraCtOr(S) or !be illformation. ;/
Accq>ted f(~ rf);t1~ IJa:.;e: Dm.Jr-1;:;o 10/25 -75
(A.ppIic:aDt (permittee) print/sign --; ZL;;. - 204 c.,' Date
NOTES: AlL WORK SHAll CONFORM wrrn TIlE ATIAOIED. APPROVED PLANS AND AlL APPUCABLE CAMPBElL SI'ANDARD
DRAWINGS AND CONDmONS.
TIlE CONfRAcroR MUST HA VB nus pERMIT AND APPROVED PLANS AT TIlE SITE AND MUSI' NOTIFY TIlE PUBUC WORKS
DEPARl"MENf AT LEASf lWO DAYS BEFORE SI'ARllNG WORK.
NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEASf 24 HOURS BEFORE RFSfARllNG ANY WORK.
APPROVED FOR ISSUANCE
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spEOAL PROVISIONS
1. Street dJal1 DOt be open C1It for UDdcrpound iDItallatiool. Minimum C1IU may be alIooMd for CODDCCtioaI or upioration boles- Such C1IU must
/ be 5DCCifica1lv WD~ bv !be Insoector nnor to C1IttiM.
-; 2. Pavement may be C1It for UDdc!pOUDd iDItallatiool _ must be ratored ill aa:orcSaoce with the Utility Trench Ratoration StaDdaId Drnin&-
~3. Work to be staked by a lioensed Land Swveyor or Civil Eqincer _ two (2) copies of the cut sheeU sent to the Public Worts Department
before;Fi' wort.
_'. l)$e ,h '!po/,~{A.- -:it -:r~Jt.~~d.a /,.) a-1ff:;;( ~. /l.rNN~
UAlfj_N Co G _" 14 /U ~_ __ () ~ t7F - -'
SI'.ANDARD
/)MOUNf
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RErP1PT NO.
PERMIT APPUCATION PEE
PLAN CHECK DEPOSIT
SURElY FOR FAIlHFUL PERFORMANCE
CASH DEPOSIT
PLAN CHECK Ii. INSPECIlON
Next $30,000-$80,000 10%; Amo\ln grea er
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h:PW PERMlT/R.ev.4/94
USA phone (800) 642-2444
(IICC other side)
TICKET NO.