95-268
aJ'Y Of CAMPBELL
DBPI'. Of PUBUC WORICS
70 North PiJIt St.
Campbell. CA 95O(B
(408) 1166-2150
BNCROAawBNI' PBRMrI'
(for workiq witbiIl tbe
public ri&bt4-way) __
I8ued //---;2 7/ 9-? J
Pamit apireI ill U IDCIL /!l
'mDit No.
X-Rd. 6Ie
95-268
AppIieatioD Date 11 / 2 7 / 9 5
AppIatioa apireI ill 6 IDCIL
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APPUCAnON - AppIic>>tioD II bercby IIIIIdc for a Public Worb Pamit ill accocdaDce witb l'~ MlIIIil:ipeI Code, Sec:tiaD 11.04. (Applu.~ apiJa
iD 6 IIIIOIltbI if tbe permit II DOt iIIucd).
A. Work IIddrea or trKt #
E/S of Wren, 20' N/O Rincon
AddftIS
1221 So. Bascom Avenue, San Jose,
777J
TcIepbooe 279 - ~
CA 95128
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Utility t!eDdl1ocatioD
B. Nature 01 wort
Main Repair, lxl cut in asphalt
C. .Attacb four (4) copies 01 aD aaiJaeered cIrawiDJ IbowiD& tbe IaclItioD, uteDt aDd di~ 01 tbe wort. Tbe dnwiq IballIIIow tbe reJatioa 01 tbe
p.-opoICd wort 10 ClliIaiDt IIIIface aDd ~ ....prowcmcDtL Wbca approved by tbe Oty BqiDeer, uid cInnriDi becomcI a put 01 tbiI permit
D. AD wort IbaII CODfoJm 10 tbe Cty'1 GeaaaI ~ S&IDdud ec.truc:tioD ~ aDd 5aaadaJd a.tructioD DctaiiI for Public Worb
0laItnacti0a; tbe GeaaaI Permit CoDditioallilted OIl tbe reveJIe aide; aDd tbe Special PIOViIioaI for tbiI pcrmit, lilted below. Paihue 10 abide by
tbae CIllDditioal aDd ~ may ..wt iD job lbut-cloMl aDd/or forfeiture 01 Paitbful Pafonaaace SuMba aDd &:lib depoIitL (See Geaeral
Permit ~tinfta 1 aDd 2.)
E. A DCIIIn:fuDcIabIe applicatioD Ice IIl1IIt &ClClOmJIMY tbiI applicatioD.
San Jose Water Company
Name or AppIic:aDt
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II tbiI wort beiDI dODe by tbe property OWIICI' at tbeir OWD raidcDce?
Complete and attacb Worken' CompeaaatioD and CoatDdOr IDformatioa forma.
Tbc AppIic:aDtfPcmlittee bereby qreea by aIfixiDa tbeir Iipature 10 tbiI permit 10 bold tbe Oty 01 Campbe11, ita oIficcn, ....tI aDd cmpIoyea flee, ute
and barmleII from any claim or dcmaDd for damapI ftIUlq from tbe wort CDV'eIed by tbiI permit
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The AppIic:aDtfPcmlittcc bcreby admcJwIcd&eI that they have read and UDdcIItaDd both tbe &oIIt and bact or tbiI pcrmit, and they will morm tbcir
CODtract01'(l) or tbc mormatiaG.
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Jane (emergency verbal)
(Applic:aDt (Permittee) print/lip
11/27/95
Date
NOTES: AU.. WORK SHAll. CONFORM wrrH 1HE ATrACHED, APPROVED PlANS AND AU.. APPUCABLE CAMPBELL S1'ANDARD
DRAWINGS AND CONDmONS.
1HE CONfRACTOR MUSf HAVE nus PERMIT AND APPROVED PLANS AT 1HE SITE AND MUSf N011PY 1HE PUBUC WORKS
DEPARTMENT AT LEAST lWO DAYS BEfORE S1'AR11NG WOR
NonCE MUS!' BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEfORE RESl'ARnNG ANY WOR
SPEaAL PROVISIONS
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Street IbaIl DOt be opeD cut for UDdcIpouDd ......tinfta MiDimum CUll may be allowed for COIIIICCticlqa or cxpIoratioD bola. Such cutl.!!.!!lt
be IIlCCificaIIv aDDnMd bv tbc IDIIIcctor Drior to cuttiu.
Pavl:mcat may be cut for UDderpouDd illltalladaal and mUll be IatOIeCI iD aa:ordaDce with tbe Utility Trcocb RatoratioD StaDdard I>nwiq.
Work to be Itated by a IicCDIed Laad Surveyor or CiYiI BqiDeer and two (2) copia 01 tbe cut 1beetI1CD! to tbe Public Worb DcpartmcIlt
before IIartiIIc wort.
rtlAICP.Kr~. Cl:i.i...AiI. M..o~ 1IA-f.,l/b. Aa.)G MKT M;.PJ...Ac& rt.MM1 JA.ctfitL.
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S1'ANDARD
AMOUNI'
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PERMIT APPUCAnON PEE S210.00
PLAN OIECK DEPOSIT $500.00
SURm'Y FOR fAlIHPUL PERFORMANCE (1OK. OP BNG. ESI'.)
CASH DEPOSIT (4~ Of SURm'Y, S500 MIN)
PIAN OIECK 4INSPECDON~~RSI' $0-$30,000 14~;
Next $30,000-$80,000 10%; Amount r $80 S200 miD)
APPROVED FOR ISSUANCE _ __
for City, .
b:PW PERMITfRev.4/94 (lee otber aide)
USA phone (800) 642-2444 TICKET NO.
s.)...2~. Ill.
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