97-110
CiTY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
~NCROACHMrnNTPERMUT
(for working within the
public right-of-way)
Pelu'll No.
X-Ref. File
9 7 -/ Iv
Application Date 1/2 q /1 7
Application expires in ~ mos.
APPUCATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application
expires in 6 months if the permit is not issued Application Fee is non-refundable).
A. Work address or tract # /;<5/ /?7c ~A/,I'tJ /1-U6
Utility trench location -S"A?nC - / AJ .s 7/2.~;c r
B. Nature of work 7J~JfJCf.u -fo R t:y'Altt S6c.V?Y' {kk./Z",j et.-I /?JAIN LI/L'€
C. Attach four (4) copies of engineered plans showing the location and extent of the work, and four (4) copies of the preli~ 1lP*' 0
Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvementya :.nlipproved by
the City Engineer, said plans become a part of this permit. \l to '-- ~ ,~
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the Gene~t Condit\~'!l"
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and prOVisions ea~~e~
job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) \>V~\.~\S~R/).
D tot- \
E. THE CONTRACfOR MUST HAVE TIllS PERMUT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY rnlPUBUC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORK.
Name of Applicant/Permittee l>>{ST UA//6y SAI'UIMl-lo,u
Address 00 IUJIU 04 t C
Is this work being done by the pro rty owner at their own residence?
X n1/huJAy sr
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Telephone 37fS -:2.4:07
Yes
i~l/
()(..
No
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free,
safe and harmless from any claim or demand for damages resulting from the work covered by this permit.
/-2~~ 97
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