95-258
95-258
arY OP CAMPBELL
DEI'!'. OP pUBLIC WOJUCS
'7D NarnII fbs& St.
r.~1\. CA 95O(Il
(4CII) 866-2UO
BNCRQAaDII!HI" PI!IMlI"
(far wadIiq widdD ...
plIbIic nps-at...,)
...... /1-13 -5b-' _(
Pamit ~ ill 12~
.... No.
x.w me
AfP ..p""ll 0... 11 / 13 / 95
A.,.=- ...... apa. ill , ....
APPUCA'nON - AppticaIiaD iI bcrcby ..... tar. PlIbIic WCIdaI PenDiI ia _ a- willa r.~ N~I Coda, SIaiaa llJM. (AppI;....... apiIa
iD 6 aaadII if ... permit iI DOl iIIucd).
=
U ·
:J =
... Q
:0 U
.. ...
u U
en.:
~~
c: u
:I ...
Q U
... ~
ClCC
... U
II
'= C
= U
= U
~
'"""
... =
~ I'll
c:.c
:I
-
= .
Q 0
...z
W
II ~
=- II
II~
U C.l
M....
up.
-
..
:: ...
_ U
~
~ B
... :I
... =
I'll
> =
Q
w....
Q ~
= III
C.l
=....
~looi
....
W~
~ C
e~
u....
Co
= CO
~....
.c: :I
w C"
=
U....
~
o U
~.c
~
w
=-=
u C
~ III
...-=
U U
>....
j~
~
U 0
.c: C
~
c:
... u
o u
~
".,
- =
:"01 I'll
~.:
=-'
0<
...en
w=
u -
U
III ~
...
... u
u-
:l.o<
A. Wort addJal or aw:r #
909 Emery, left side, n/o Sunnyoaks
3x4 cut in dirt
~
c
e
r
('
~
~
r
t"
~
t"
t
t
.
Utility aads IocaIiaD
B. Nat1Ift d work
C. .Aaadl four (4) c:opieI d u eqiDcaed dnIwiq IIaoIriq me icaIiaa. CIIIaIIad ~... . - d me wart. 11Ie dmriac 1baII.. me reIaIiaa d the
...~ work to cmamc AIfacc aDd UDlk.......md b..ro..- --- ..... "'I'I'"4Wd by .. aty PAP-, aid dnwiDc t.a:ImeI. put 01 tbiI permit.
D. .AJl1lOlt shal1 c:oafOl1ll to tile Oty'1 GcaaaI r-,,-,~ Studud a....aioD Fi....;R"t- ad 5aadard c.c..nx:aaa DeIaiII tar PabIic WortI
CcraIauaioa: me GeaaaI PemUt r-"-'~ Iiaed ma die .- silk; ad die ~ PIvriIiaaa I,.... pamit. IiIIed bear. PIIiIme 10 abide by
tbae caaditioal ud ~ IU1 rauit iD jab ...... ud/rx forfciaIR 01 pai&bfW PaforaIaIIc:e SurctieI aDd c.a depaIiu. (Sea GcDcral
Pamit Coaditioall aDd 2.)
P. A aaarcfuDdablc appiic:atiaa fee mUll .... 1-'" tIaiI ~. Aft ..
San Jose Water Co.
g
Name d Applicant
T~ 279-7825
.
~
('
c
...
~
'-
AddraI
1221 So. Bascom Ave, San Jo~P ra Q~l?Q
II tbiI wort beiDc claDe by me ...~TJ CMIIU at tbeir an ftIidaI:&?
Ya
No
Complete aDd.uac:h wortas' CclaIpeua&iaa aDd CclDtDctar lafonl'...... fea..
Tbc ApplicaDlfPezminec bcftby qna by aftI:Iiq tbeir IipacImI to dill pamillO bo6d .. at)' 01 r_.."...u. ita Clftk:as,..... ad UIlllc:I- fnIc, 8Ie
aDd humlaI from uy daiID or dcmaDd for dIIaap:I naitiq fJaaI me wort aMnd by tbiI pamit.
The Appiic:aDt/perminee beftby act:DcJwIedpI dW tbcy .... tad aDd ~-t bat.b me fraaI aDd ba d tbiI pamir. aDd tbcy wiD iDtorm tbeir
CIClIlmctor(l) 01 the iDtmmatioa.
~_ Jane/Dan (verbal emergency) 11/11/QS
(AppUcut (Penmnec) pIiDI/lip Date
Noms: -AU. WORK SHAU. CONfORM WrI1I1'HE A1TACIED, APPJtQVED PlANS AND AU. APPUCABI.E CAMPBEU. STANDARD
DRAWINGS AND CONDmON5.
THE CONnACI'OR MUST HAVE nus PERMrf AND APPROVED PlANS AT 1lIE srre AND MUST NO'I1PY nil! PUBUC WORXS
DEPARndENT AT LEAST TWO DAYS BEPORE srAKIlNG WORK.
NanCE MUST BE GIVEN TO PtmUC WORXS AT LEASI' 24 HOURS BEfORE RESfAltI1NG ANY WOIUC.
SPECIAL PROVISIONS
_4.
SCrect shal1 DOC be opeD cut for 1IDda&i()Wld """DaaI MiDimum MI mar be aIJoRd for ~~ or e.zpIonac. bcl6eL SudI CU1I.!!!!!!! ;;
be mecific:aJJv .ODrovm bY tile Ilmlecrar mior to cuttiM.. C
~meDt may be: cut (or UDderpauad i..tioaf aDd mUll be I'CIIIOZed in ~ with die Utility Treacb R.eaanDaa StucIud 0rniDJ. tl:
wor* to be aa.te.d by . IiceDIed l.aDd SuIwyor or Ovil PAJi- aDd two (2) ~ 01 die aJllbeeII leat 10 die Public WorD DcpuuDeAt ~
before IW'tiDI waft. C"':
C
:J:
"1:
t""
~
~
~
t:
tl:
to<
STANDARD
~OUNr
S.-:?d. S' -"
s -
S
RE/"P11'T NO.
_1.
_2-
_3.
APPROVED FOR ISSUANCE
b:PW pERMITfRev.4/94
USA phone (800) 642-2444
$210.00
ssoo.m
(1~ OP ENG. EST.)
(4~ OP SUREJ'Y. SSOO MIN)
(PIRST 14~
mill)
~
PERMIT APPUCA'nON PEE
PlAN CHECK DEPOSrI'
SUREI'Y FOR PAlllIFUL PERFORMANCE
CASH DEPOSIT
PlAN CHECK cl INSPECIlON
Ncn $3O.(lOO..SSO.CXXlIO'%; AmowlI
../
---
s -
s / d-.<:l .-/
(~
n
t-'
~
to<
-
(lee other side)
* *
TICKET NO.