97-121
CITY OF CAMPBELL ENCROACHMENT PERMIT P 1it No. Q'7 - / 2-1
DEPT. OF PUBUC WORKS (for- working within the J. File
~~::;I,F~~ ;~OO8 public r~-Of-wa/y) 0-n-,~ ) c,R roE C ,
(408) 866-2150 Issued~d(P 9 lc57 " .,0 Application Date ..2- I -;/;;7 I" E
Fax (408) 376-{)958 - Pennit expires in {2 mos. Application expires in 6 mos. I FEe I
APPUCATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.0;5u_(APpi?cllol997
expires in 6 months if the permit is not issued Application Fee is non-refundable). 4DM"t./C VVU
# 0 A _ . 1N1srR. <(/(5
A. Work address or tract # //4-.l. ANJJ //.5:. JrtlrU,.,.-utE:: " 4rlON
Utility trench loca~" SOUrH ~ r1I~ NaL~ -:;t'QJ~'<"7 /.../Ne:. oP" ..yH~r# Av~
B. Natureofwork C!.u"--oF~ (2)ca4s SEzet./rCJ!;;S. S.D. # .4I(:::,c147'Ol)
f<e-.tJJu 1IC.(Ai(3 CZJ 4-' X-4 L)E:;.LL 1Io,-~
C. Attach four (4) copies of engineered plans showmg the location and extent of the work, and four (4) copies of the preliminary Engineer's
Estimate of work:. The plans shall show the relation of the proposed work: to existing surface and underground improvements. When approved by
the City Engineer, said plans become a part of this permit.
D. All work shall confonn to the City of Campbell Standard Specifications and Details for Public Works ConsLruction; the General Permit Conditions
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in
job shut-down and/or forfeiture of Faithful Perfonnance Sureties and cash deposits. (See General Pennit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HA VB TIllS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY TIlE PUBUC 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 ApplicantlPennittee
Pacific Gas & Electric Company
Telephone (408) 725-2022
Address 10900 North Blaney Avenue. Cupertino. CA 95014'
Is this work being done by the property owner at their-own residence? Yes No
The ApplicantlPermittee 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.
TIle ApplicantlPermitu5e hereby acknowledges that they-have read and understand both the front and back of this permit, and they will infonn their
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