95-263
an OP CAMPBELL
DEPT. OP PUBUC WOIUCS
'70 North P"U'It St.
Campbell, CA 9SOlI8
(408) 866-2150
ENCROAawENI' PERMIT
(for worIdJII witbiD the
public ri&bt4-way)
IIIued (/-~C1- ~aJ
Permit expiJa iD 12 ~
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acrmit No. 95-263
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Applicatioll Date 11/20/95
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APP"...ICAnON . Applicatioll ill bcn:by made for a Public WOJb Permit iD accontuce with Campbell MlIIIicipaJ Code, Sec:tioD 11.04. (Applieatioll expiJa
iD 6 mnatbl if the permit ill DOt iIIued).
AWorklldclreaortract# East side of Harrison - 200' south of Hamilton
3'x3' cut in asphalt to investigate plugged gas service
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Utility treac:b katioa
B. NatuJe 01 work
C. Attach four (4) copieI 01 all ~ drawiD& IbowiDa the Ioc:atioIl, ClteDt aacI dimeaIioaI ot'tbc work. Tbe drawiD& IbaI1Ibo1r the rdatioll 01 the
propelled work to eziItiD& IU1'fIce aacI UDderpouad iIDprovotlllCllts. WIleD approved by the aty &peer, uid cIrawiDc bccoma a put 01 tbi& permit.
D. All work IbaI1 coaform to the aty'1 OeDeral CoDditioal, Standard ConItructiOD PrcwiIioaI aacI Standard ConItructiOD Details fOC' Public Worb
Coamuctioa; the GeDeral Permit CoDditioallilted 011 the m.oene aide; aacI the Special PrcwiIioaI fOC' tbiI permit, lilted bckwt. Failure to _ide by
tbae CODditioal aacI proYiIioaI may reIUIt iD jab lbut4JwD aacI/OC' forfeituJe 01 PaitbfuI Perf~ Sureties aacI cub depoIits. (See OeDeral
Permit CoDditioall aacI 2.)
E. A IIOIlJ'CfuDdable applicatioll fee mUll accompaay tbiI applicatioll.
Name 01 Applicant
pacific Gas & Electric
T~ 725-2176
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Addrea
10900 North Blaney Avenue, Cupertino, CA 95014
II tbi& wort being dODe by the property owner at their own taidenc:e?
Yes
No
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Complete BDd attKh Workers' CompeDllltiollBDd Contractor Information f01'lDl.
Tbe AppIicant/permittee hereby apeeI by affixiD& their IipatuR to tbi& permit to bold the City 01 Campbell, its of6c:cl'l, &pats aacI empIc:JyeeI free, ufe
aacI barmleII from ally claim or demaad for damaplRlUltiDg from the work COYCRd by tbi& permit.
The AppIicant/permittee hereby ac:lmowIedps that they IYM read aacI UDdeI'ltaDd both the front aad bact of tbi& permit, aad they will inform their
COIltractOr(I) of the information.
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Norm Feyling (EMERGENCY VERBAL)
(Applicant (permittee) print/lip
11/20/95
Date
NOTES: ALL WORK SHAlL CONFORM Wl11f 11IE AlTACHED, APPROVED PLANS AND ALL APPUCABLE CAMPBELL STANDARD
DRAWINGS AND CONDmONS.
11IE CONTRACI'OR MUST HAVE nus PBRMIT AND APPROVED PLANS AT 11IE SITE AND MUST N011FY 11IE PUBUC WORKS
DEPARTMENT AT LEASI'lWO DAYS BEFORE STARTING WORK.
NonCE MUST BE GIVEN TO PUBUC WORKS AT LEASI' 24 HOURS BEFORE RESfARTING ANY WORK.
SPEaAL PROVISIONS
PERMIT APPUCAnON PEE
PLAN CHECK DEPOSIT
SURB1Y FOR PAllHFUL PERFORMANCE
CASH DEPOSIT'
PLAN CHECK cllNSPECI10N
Next S30,OOO-$80,OOO 10%; Amoun greater
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Street IbaI1 DOt be opea cut for UDderpouad iDIta1Iatiolll. MiDimum cull may be allowed for c:omtec:tioaI or cxpIonatioll boles. Such cuts.!!!!!!!
be IDCcific:aIIv aooIOYCd bv the lDsoector >>rior to cuttill2.
Pavemeat may be cut for UDdeIpOUDCf iDIta1Iatioal aad mUll be J'CItored iD accontuce with the Utility TRac:b RatoratiOD StaDdanI I>rawiag.
Work to be Itated by a lic:eDled Laad SuIYeyor or CMJ &peer aad two (2) c:opieI 01 the cut lbeets leat to the Public Worb DeputIIICIlt
befOll: ItartiDg work. .
use M.f:lJJdt1 IA "f/2cpJcd ~'>T()flA::1J... "V.
STANDARD
AMOUNl'
sJ.:25.00
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RPrRTPT NO.
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APPROVED FOR ISSUANCE
* *
h:PW PBRMIT/Rev.4/94
USA phone (800) 642-2444
(see other aide)
TICKET NO.
"")III"". CITY OF CAMPBELL
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)pc;' (j..; /L;rv",j .
PROJECT NO. 95 J )0J
REPORT NO: (
DATE: 11/14 C] \'
WEATHER: (1--1;'2
INSPECTOR: K. ~~S1fALL
FIELD ENGINEER' S DAILY REPORT
CONTRACTOR: P G U
ITEM
DESCRIPTION
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