95-267
crr'i OF CAMPBEll.
DEFT. OF PUBUC WORKS
10 North P'U'5t St.
Campbell. CA 9SOO8
(0) 866-2150
ENCROACHMENT PERMIT
(for WOI'tiD& within the
public ript4-way)
JIQICd / I .) 7 - C).j/JD- J
Pamit czpira ill U ID05. .
lit No.
)I.-Rd. file
9'6-- ex,} ~ '7
Applicatioo Detc / / -.2 7 - 9"",,~-
Applicatioo czpira ill 6 IDOl.
APPUCATION _ Applicatioo i& hereby ID8dc for a Public Worts Pamit ill aa:ordaDce with CampbdI NUIlicipaI Code, Sec:tioo 11.04. (Applicatioo apiJa
ill 6 moatbl if the permit i& DOC iIAIcd).
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A. Wort 1Iddrc& or tnld #
\ 433
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c. Attach four (4) copies of all eqiDecred cI.nwiJIIlbowiq the klcatioo, eDeIlt aad ctiaKIIAoaI of the work.. '!be cInwiq IballIbow tile rdatioo of the
propoiiCd wort to exiItiD& lW'face aad UJMSeflJOWld improYelDCDtI.. WbcD ~ by tile oty EqiDccr, said drwwiD& becomes a put of this peraUL
D. All wort IbaII coaform to the Oty'I Ocoeral CoIlcSitioos, StaDdard Coamuc:tioIl ProYi5iom aad StaDdard CoaItnIctioo Details for Public Worts
CoDstructioa; the Geocral Permit CoIlcSitioos 1istCd 0C1 the ~IIC side; aad the Special ProYi5iom for tbi& permit, tiItcd below. pailuft to abide by
tbese coaditioos aad provisioas may rault ill job dlut-doMl aad/or forfeiture fA Paithful Perf'ormaDCC Sureties aad c:adl depocitl.. (See Geoeral
Permit Cooditioos 1 aad 2.)
E. A DOI1J'Cfwldab\c appIicatioo fee must IICCOIIIpUl)' tbi& application.
Pacific Gas & Electric Company
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Utility treDCb Ioc:atioo
B. Nature of wort J 00 tt 2 ( 1 t (J, v \ '- E
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Name of Applicant
Addres5 10900 North Bl aney Avenue, Cu erti no
~.~ 408-725-2022
Jr f!.: C E
Is this wort bein& doDe by the property OWDCr at their OWl! resideDce? Ya No /fD1I2 'l .~
Complete aDd attach Worke"' CompellAtioo aDd COGtractor h1formatioo f0nD5. <;."'~i.jC ~--
The ApplicantfPermittcc hereby av- by aftildDc their lipaturc to tbi& permit to bold the Oty of Campbd1. its oI6oer5, ~NJSJ;e+ free, lafe
aDd barm1C1& from allY daim or dcinand for damap raultiD& from the wort COYered by this permit. '^"
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CA
9501
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::~~~~r;m~.-~~...,.! thaI th<y.... .... ... -...... both ... ........ bod ...... _" ... th<y'" "'''''''. their
Accepted LJ.Y/4-~ L~"---' ( ~ r t PH f jJ [ H RJ}- r ) II - f 7 - ~ f
/ (Applicant (permittee) print/sip / Detc
Nares: All WORK SHAll. CONFORM wrrn TIlE ATIAOIED, APPROVED PLANS AND All APPUCABLE CAMPBEll STANDARD
DRAWINGS AND CONDmONS.
TIlE CONI'RAcroR MUST HA VB lHIS PERMIT AND APPROVED PLANS AT TIlE srre AND MUST NOTIFY TIlE PUBUC WORKS
DEPARlMENT AT LEASI' lWO DAYS BEPORE SfARllNG WORK.
NOTICE MUSf BE GIVEN TO PUBUC WORKS AT LEASI' 204 HOURS BEPORE RESfARllNG ANY WORK.
SPEaAL PROVISIONS
APPROVED FOR ISSUANCE
SfANDARD
$210.00
SSOO.OO
(100* OP ENG. ESf.)
(4% OP SURElY, SSOO MlN)
(PIRSf $0-$30,000 14%;
,000 7'%, S200 miD)
AMOUNI'
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Street IbaII DOt be opeD cut for UDdcrpouDd iDstallatioos. NiDimum cuts may be aIJoMd for ~ or upIoratioo bola. SudI cuti must
be IDCCificallv InnJ'OYl:d bv the lDsnector Drior to cuttin2.
PavemeDt may be cut for UJMSerpound iDstalIatioos aad must be restored ill aa:ordaDCe with the Utility TreDCb Restoraboa StaDdard ~
Wort. to be staked by a 1iccDSCd Land ~ or Civil P..DaiDeer aad two (2) copies of the cut sbeeti KDt to the Public Worts DepartmeDt
before ItartiD& work.
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PERMIT APPUCATION PEE
PlAN 0lECK DEPOSIT
SURE'IY FOR FAm-IFUL PERFORMANCE
CASH DEPOSIT
PlAN CHECK &. INSPECI10N
Next S30,~$80,ooo 10%; Amou
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b:PW PERMIT/Rcv.4/94
USA phone (800) 642-2444
(see other side)
TICKET NO.
AP.PROVED FOR \JONSTRUCTION.
C:'t"1 Of Campbell . /..
I) 'I, 1s -db 7
Public \Narks PermIt Noo---'
h these plans
Contmctor must eve .
.L . b site during construction.
on tHe 10
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