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arY OF CAMPBELL ENC&OACfNENI' PBRMIT
DEFf. OF PUBUC WORKS (for 1I'OItiq within the
'70 North First St. public ript~ )
=2~- ~!f2l'J~ =::.:~:::~
APPUCATION . AppIicatioa iI bcreby made for. Public Worb Permit ill aa:ordaDcc wIdI r~.u NuaicipIJ CodC, ~'11;'. 1i(~~
ia 6 IDOIlW if the permit iI DOC iIIued).
A. Woctaddl'CllOltnlCt# 7i4c-T 87.1/ (.23<1 ~EMJ~r.: ~())
Utility treada Iocatioa PE.D /) I Itl a )2 1)
B. Natuftohort /1/f7"4Ll C4 MAw !lYOQAAIf. r;g'f/r~r A.vD [)Nc(J1./II/E~r / 1'eR.VI("~ (E 6-2.0S)
/ I
c. AttacII four (4) copies ola eqiDecJed drawiDc 1bowiDc!be Iocatioa, alcDt _ ~q;tD.IiDIII ol!be.... nc drawiDc"""-- die NIatioa ol tbc
ptopoICd wort to exiItiD& lUtfacc _ UDdcIp'OUDd imptc:wemeotl. Whaa ~(Md by tbc Oty &peer, aid 4rMriDc bocomea . put ol tbiI permiL
D. AD wort IbaD CODform to !be Oty'1 0cacnI CclDditioaI, SIudard ec.an.ctiotl ProviIioaI _ SIudard ec.an.ctiotl DcIaiIa far PubIk WOIb
CoaItructioa; the GeDeral Permit CODditioallilted OIl the revase Iide; _ the Special ProviIioaI far tbiI permit, lilted below. IWhae to abide by
tbcIe eoaditioal _ JmMIic- may rauJt ill jab llaut4MD. _/ex fodciturc ol PaitbfuI PaforJllaDCC Sureties _ CMb dcpaIitl. (See GeDeral
Permit CODditioall ad 2.)
Eo A aoorefuDdable appIic:atioa fee 81111t IICICIllIIlJIUY tbiI appIic:atioa.
Name ol Applicant nAl (k,.r!' (j) AlE/;. Q 1'11'-4111"
AddI'Cll /22/ J: AAJ"'cOM AVE J)A/ J,J'E: (';4
Permit No.
X.Jlef. file
1b-I/3
,,17 ~< 2:} 199~'
Tdepboae .2 71 - 7847
9~/Z8
V No 001lW: Corr. !'ZC9s-o
I
II tbiI wort beiDa doae by the property 0MIeJ' at their on raidcDcc?
Ya
Complete aDd attach Worters' CompeDAtioa aDd CoatnlCtOr lDformatioa fOl'lllS.
nc AppIicantjPermittee bereby apeeI by atrixiq their lipatuft to tbiI permit to bold tbc Oty ol r.~.I\ ill oI6cers, ....tI ad caapIoJal free, afe
ad barmIea from ay daim or demand for damap raultiD& from the wort aMJed by tbii permit.
The AppIicantjPermittee bereby ~ that they IIaYe rueS ad UDderstaDd both the float aDd bIICt ol tbii permit, ad they will worm their
COIltnlCtOr(S) of the iDformatioo.
25
Dete
Aacpted
NO'IES: AU WORK SHAll. CONFORM wrrn 1HE ATIAamD, APPROVED PlANS AND AU APPUCABLE CAMPBELL STANDARD
DRAWINGS AND CONDmONs.
1HE CONrRAcroR MUST HA VB 11DS PERMIT AND APPROVED PLANS AT 1HE srre AND MUST NO'l1PY 1HE PUBUC WORKS
DEPARTMENI' AT LFASI'lWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEASI' 24 HOURS BEFORE RESl'ARTING ANY WORK.
SPECIAL PROVISIONS
_1.
Street shall DOC be opeD cut for 1IIIdeqrouDd iIIIta1Iatioaa. NiDimum cuts may be aUOMCl for CIOIUlCCtiODs or CIpioratioa bola. Such cutl must
be S'DecificaUv ~ bv the lnsDector Drior to cuttin2.
hYemeDt may be cut for UDderpouad iDsta1Iatioal ad mull be nstoJed ia acc:ordaDce with the Utility TIaIdI RatoratiOD SIudard I>rniq.
Wort to be staked by a 1iceDIed Laad ~ or QviI &peer ad two (2) copies ol the cut mcctlleDt to the Public: Worts DeputmeDt
before ItattiDg wort.
~~~ ::::;:: p~":lJJ.r~ 1~~)<."'" F..eoN( IHA/~ 1'<1 N~ot>f5.hr\1 U,Je:. J'I1t'(itOlJ '1/ A.UAwAAIF. IAI-"',w:;-'
_2-
i
STANDARD
AMOUNr
RPf'FIll'T NO.
PERMIT APPUCATION PEE $210.00
PlAN CJIECK DEPOSIT $SOO.OO
SURElY FOR FAIlHPUL PERFORMANCE (1~ OF ENG. PST.)
CASH DEPOSIT (4~ OF SURElY, SSOO NIN)
PlAN CJIECK & INSPECIlON PEE (FIRST $0-$30,000 14%;
Next $3O,~$80,OOO 10%; AmouD~~t thaD FAooo;;"'" S200 miD)
APPROVED FOR ISSUANCE~~
for Eqineer
II:PW PERMITjRev.4/94 (see other side)
$ J..).'S ,u..
$
$ -
$ -'
$';/o.u ..
62
Q
/_!IJ?~ .
Date
* *
USA phone (800) 642-2444
€'.r
TICKET NO.