95-250
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CTY OF CAMPBEll..
DEPT. OF pUBIJC WORJCS
iO Norm Pbs& SL
~u. CA 9S(XB
(4(11) ~2J50
BNCRQAaIMI!NI' PI!ItMIr
(far waddill widda die
JIlIbIic npt.aI.-y)
.... II - / - 95 fJltd
..... apira iD 12 maL
...... No.
x.IIf. file
95-250
Aft.. ~.. 0..
AW' ...lft..... ill 6 ...
11/1/95
APPUCA"nON - AppIicatiaD iI berebr..... far. PlIbIic WCIIb PaIDiI ill .. r.- wtda r..."...... ~......... CadI. SIaiaa lL04. (AppI.,...... apra
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A. Woft: addraa or u.:t #
N/S of Grant, 25' W/O Second Street
Main Repair, 1x1 cut in asphalt
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B. Natun d wort
C. A!tIdl four (4) capieI 01.. eqiDccnld drIwia&.... lbalcll::8liml, ......... 51:;r '.. 01.. wadr. 'DIe dnIwiq IlIaD -- .. ....... 01 die
...UPWMd wort to c:siItiDc IIIIUa: .... .............d L..ro,....... - .. ..... .......-... bJ .. 0lJ P,;--, IIid dnwiq bIalaII& . put 01 tbiI pamiL
D. AD WOIt sbaJI caaform to me Oty'1 GaIenI r.....~ S&IIIdud ~ l'iOl'Wr- .... SIadanI c.c:..naaiaa DeaiII far PabIic WOIb
~ tbc GeacraI Pamit o-tltVw ..... aa .. _aide; .... Dc SpIr:8J ~Or'" far ddI pcnIIi&. .......... F.ibn ID Uide br
dIcIc caaditioal aDd pnM5iaaIlIIIIY' .... ia jab 1IUIa~ _lor faIfciaIa d FaidIfuI PaianaaaI:e SuIaieI aDd mIb depaIiIL (See Ge:Daal
Permit Coaditioall aDd 2.)
E. A DODJ'CfuDdabIe qplicalioa fee ID_" I-ey tbiI tpIlli~~-
Name of AppUc:aDt
San Jose Water Company
T~ 279-7825
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1221 So. Bascom AvenllP !=:r1n .TrlC:::<=> rll QI:\1 ?H
II rhiI wort bciDI daDc bJ tbc I"~ CMIICI' at tbeir Oft ...-.z?
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No
Complete aDd attlCh WortaI' CampaIIuioD aDd eaaa.aor 1afonDa..... fma.
The AppticaDt/perminee bcrcby apea bJ aftbr:iq tbeir........ to dill paS to bDkI .. 0lJ 01 r-r-u. ita dcI:a, ....ad uq' ,- flee, ale
UId harmicII 110m uy daim or cIaaaad for damapI ~ f1aa 1M walt CIlMftllI bJ dIiI pamiL
The AppIic:aDt/permittee bereby ac:tDoMedpI dial tbcJ IIave sad aDd __M botIl 1M fraaI aDd '** 01 tbiI pamit, aDd tbcJ wiD iJIfoIm dIeir
CDDU'KlOI(S) of the wonaatioa.
Aa::epted
Jane (emergency verbal(
(AppUc:ut (Paminee) JIIiDI/Iip
11/1/95
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Nares: -ALL WORK SHAU. CONfORM WI11f 'IHE A1TACIED. APPROVED PlANS AND ALL APPlJCABI.2 CAMPBEU. srANDARD
DRAWINGS AND CONDmON5.
'IHE CONI'RAcroR MtJ5r HA VB nus P!!RMlT AND APPROVED PlANS AT 11IE s:rre AND YU5r NO'llPY nm PUBUC WOJUCS
DEPAR'IldEm" AT 1.EASI' NO DAYS BEPORE 5rAJl11NO WOK
NonCE MU5r BE GIVEN TO PlJBIJC WORKS AT LE.A5l' 2A HOURS BEfORE RESI'AJn1NG ANY WOlUC.
SPECIAL PROVISIONS
_1.
SIreet sbaJI ... be opeD cut for WKk.........d ~II...... Yiaimum CII1II1111Y' be aIJoRd far Po ""II~ or apcntiaD boAeL SudI CII1I must -;::;
~ mecific:alJv mmoved bY me IDsDecmr mior to runiDE. C
hvaDeDt may tN; cut for uadcrp'DuDd i.......llatW.- aDd Ia_ be rcaund fa aa:anIace wida me Udtily TI'aICb R.wlh... StaDdad Dnwiq. t:C
Wort 10 be su.ted bJ a IiceDIed 1.&Dd Surveyor ar Ovil pftJi- aDd two (2) capiIa fII tbe CII& ... sat 10 &be Public WOIb DepuuDctlt ~
before SWtiDI 'lII'OI't. ~ . '
I1Sr, l11r.::iHdtl ')(r NII1UrJU'"
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n'ANDARD
NdOUNI'
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(1~ OF ENG. ESI'.)
(4" OF SURElY. SSOO YIN)
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PERMIT APPUCA"nON fEE
PlAN CHECK DEPOSIT
SUREIY FOR PAIlHPUL PERFORMANCE
CASH DEPOsrr
PlAN CHECK .t. INSPECIlON PEE
Ncn $30,000-$80.000 1090; AIDouAt
APPROVED FOR ISSUANCE
h:PW PERMIT/Rev.4/94
USA phone (800) 642-2444
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/1 J 7' S
(see other side)
* *
nCKE'l' NO.
CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
ITEM
cc:
Jt:t.... JO.l'~ W.,..fp,,-
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CONTRACTOR:
2 r- I Lv' /0
2~'; JI.
sP..... JC;~ t-/(l.f.ey
DESCRIPTION
PROJECT NO. cy ~- 2 ~O
REPORT NO:
DATE :
WEATHER:
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