97-151
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell. CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENTPERMUT
.fof working within the
'PUblic right-of-way)
Pe"'lit No.
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APPUCATION - ApplicatiOli. is hereby made for a Public Works Pell11it 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).
Application Date~Z e> A'/
Application expires in 6 mos.
A.Worl<""",,,o,_# ~~Q ~~\ t~~~ Nu<;
Utility trench location G.. I,E<" ~"} S'" t"'l..!;::> ~'--~ "7
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S.D. # e050Z2 _
B. Nature of work
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C. Attach four (4) copies of engineered plans showing the location and extent of the work, and four (4) copies of the preliminary Engineer's
&tUruote of _t. Th, pJ"", ""'" "'ow tho <datioo of tho p,""""" wo,t to ,,,,ling ,""'" "'" -'growul impro'" .llilreo 'Ppro"'" by
th, Clty Eog;".",. ,.;d plan> b""'n", "'" of th. Ponnil \.: I! '" I!
D. All work shall confoll11 to the City of Campbell Standard Specifications and Details for Public Works Construction; the Ge~eW1!t Conditions 0
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and p@'fi"~6 &~ in
io!> ....,-<In.... """'" fod,itu" nf Pmthful Fedo""""", Suretie, """ "'" _. (Soe GenomI P"",it Coodltin", , """ "lllUSltC """"
~[)MJA' WOlVe
E. TIIE CONTRACTOR MUST HA VB THIS PERMIT AND APPROVED PLANS AT TIIE SITE AND MUST NOTIFY 'I'm!~~/~RKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 'tiBURs
BEFORE RESTARTING ANY WORK.
Name of Applicant/Permittee
Pacific Gas & Electric Company
Telephone (408) 725-2022
Address
Is this work being done by the property owner at their- own residence?
Yes
No
The Applicant/P~rmittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free,
safe and hannless from any claim or demand for damages resulting from the work covered by this permit.
METER/MANIFOLD DES IN
INSTALL 2"NANIFOLD WITH
AS SHOWN
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THREE OUTLETS,
RECEIVED
APR 281991
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FIN. GRD.
APPLICANT TO STUB HOUSELINE 6" FRON WAll,
WITH ADDRESS TAG
TYP TRENCH SECTION
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FOR01AN'S'IOTES
lNSiRLL 26' OF 1" PL SERVICE
COMPLETE! 1/4"NC. RISER
~;T~ :/:" aYPASS
~G&E TO JO ALL TRENCHING
8ACKF!LL AND PAVING
:ITY OF CAMBELL PERMIT RED.
.USTOMER TO INSTALL NE~
, SIDEWALK, CURB AND GUTTER
.AlL USA PRIOR TO TRENCHING
I [800l 227-2600
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CUSTOMER TO INSTRll
NEW SIDEWALK
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APPROVED FOR CONSTRue ION.
Cit\; of C>:1,rn he!!
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