92-118
CITY OP CAIIPULL
DEPl'. OP PDBLIC WORD
70 North Firat St.
CUpbell, CA 9!i0~
(408) 866-2150 .
Pamit Ho. 92-118
EIICROACIDIEIft' PERIII'l'
(for worJt1nq within the
public d;ht-of-vay) X-Rat. fUe
Issued a~ r1. 9 V Application Date 2/13/92
Penait expi 12 _. . Application expiru in 6 IIOS.
APPLICA'1'%ON - Application ia hereby ..de for a Pabl1c Worb PeE1lit in accordance with Caapbell
MUnicipal COde, Section 11.04. (Application ezpiru in 6 montb8 if permit not pulled)
75 Union Avenue
A.
Work address or tract .
Utility trench location
B. Nature of work:
Breaking out concrete to do repair.
C. Attach five (5) copie. of a drawinCJ abowinq the location, extent and dillenaions of the work
The drawinCJ aball .how the relation of the proposed work to exiatinCJ surtace and underqround
iIIprov_enta. When approved by the City EnCJineer, ..id drawing becoae. a part of this penlite
D. The General Conditions for all permits are listed on the reveree side. Special Proviaiona tor
thia permit are listed below. Failure to abide by th_e conditiona and proviaions IllaY result
in job shut-down and/or torteiture ot Faithtul Pertorlllance Sureti_ and cash deposita. (See
General COnditions 1 and 2).
E. An appl1cation t.. wst accoapany thia appl1cation.
Nue ot Applicant Pacific Bell
145 South Montgomery, Room 119,
Address
'1'Ilia tee ia non-refundable.
Telephone: 4 9 1- 2 0 3 9
San Jose CA 95110
Is this work beinq done by the property owner at their own ruidence? --3es _no
complete and attach Worken' COmpensation and COntractor Information tOrlllB.
The Applicant/Permittee henby aqrees by aftixinq their dqnature to this permit to holeS the City ot
Campbell, its otticer., aqent. and ..ployee. tree, .ate and harmles. fro. any claill or daund for
eSuaqes r_ultinq trom the work covered by this permit.
The Applicant/Permittee hereby acknowledqe. that they have read and understand both the front and
back at this permit, and that they will intorm their contractor(s) ot the intormation.
ACCEPTED Bobbie Brehm (Emergency Verbal) 2/13/92
Applicant (Permittee) print/.i9ft Date
NOTES: ALL WORK SHAL". CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE COHTRACTOR HOST HAVE THIS PERMIT AND APPROVED PLANS ON-SITE AND HOST MEET WITH THE P.W.
INSPEctOR ON THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK. APPLICANT HOST CONTACT THE INSPECTOR
'1'0 ARRANGE FIELD MEETING.
NOTIa: HOST BE GIVEN TO PDBLIC WORltS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVYSIONS
~
_1.
_2.
Street shall not be open cut tor underqround installations. Kin1llum cuts may be allowed
tor connections or exploration holes. Such cuts must be soeciticallv aooroved bv the
Insnector nrfor ~o cuttina.
Pav_ent may be cut tor underqround installationa and muat be restored in accordance with
the Utility Trench Restoration Standard DrawinCJ.
Work to be .taked by a licensed Land Surveyor or Civil Engineer and two (2) copies ot the
cut ab.et. .ent to the Public Work Department before ..tartinCJ work.
The hours of work are lillited to out.ieSe the hours ot 7-9 a.m. and 3-6 p.m. tor any work
attectinq a trattic lane.
_3.
_4.
_5.
STANDARD
AMOUNT
RECEIPT NO.
PERJaT APPLICHION l"D
PL&II CHECK DBPOSn'
SORETr FOR FAn'BPOL PERFORllAHa:
CASH DEPOSn'
PL&II CHECK " IJfSPECTION FEE
$100,000 - $500,000
APPROVED FOR ISSUANCE
t: PW PERMIT
Revised 10/91
$ \ C1"S. ec>
$
$
$
$ \O~.OC)
~
$105.00
$500.00
(loot or ERG. EST.)
(n OP stmftI', $500 1IDl)
($0-$100,000 lot,
en, $100 1IDl)
Cf
""L - \ ~ _oYt--
Date
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