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APPUCA'nON - App~rioa illIerebr IMde far. PabIiI: WCIIb Familia ...... widl r.."..... ~........I Code. SIeIila lLCM. (Appio-tinft apza
ill 6 IIIDDdII if tbc permit iI .. --).
A. Wort.sdra& or tIW:t #
Corner of Kennedv and Tnilllc::t-ri:.l
Utility aadl Jocatiaa
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B. Nature d warS
EMERGENCY Main Repair - 4'x5' Cut in Asphalt
C. Aa.dl four (4) c:apia ol.. cqiIlccrcd drniac IIaaIriq -1aI:labI. CIIIIIII'" .1 . - ollila WIlIIL ne cImwiq IlIaD .. dill ftIadaa 01 dlc
...~ worE to ClI:iII:iJIIIUIfacc ......... ......... h..to-..-'" .... WIaIa -wo..M by dill a&y ~,,-.r. aid cIaIwiDc, bill-. . pili d tIIiI permiL
D. .AIl.art sAaJl caafonD to the Oty'1 Gcaeni r-""'fl~, SIaDdud c.a.a...Daa l'Juriliv- ... SIadud ~ DaaiII far PabIiI: WOIb
c:o..mxDaa: tbc GeaaaI Permit ~itVw tilled ca cba rneaa ..... .... cba .sp.a.I Fzo." ..,. dIiI pIIJIIiI. .......... PIibn 10 abide by
dIac c:aaditioa& ud JllUl'iIiaaI may rauit ill jab 1lllu4IMI ud/or fadcialrc d FaidItuI ~ ..- SuaaieI ud... depaIiIL cs- GaaIJ
Permil Q:loditioa& 1 aDd 2.)
Eo A IIGIII'CiuDdabIc qpIic:al:Dl fee 11I1II& .. I 6, dill '91......~ ..
Name d AppUcaDt
San Jose Water Companv T~?7q-7Q7Q
1221 South Bascom Avenue, San JosP. rA qSl?H
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II lhiI.art beiq daac by the I"'~ oner at tbeir OR ftIiIIeIaf
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Ccmpcle ucI attaCh Worten' ~ aDd r., ...-lafanIIaIiaa fCIIIIIL
The AppticaDl/penmtlec bcn:Dy qrea by UIIziq dMir ........ 10 dill pamillO ba6d me atr ol r....,,-u. . CIftIcas. .... aDd · aipoi' ,_ free. ale
aDd Il.umJaa from uy daim or dcmud for dImapa ....... fft:lID d1111IIaIt aMnII by dIiI pamiL
The Appik:aDl/penmtlec beftby acbIowiedpIlIIII tIIcf.... sad aDd ~ bclda cba fraDlud blIct ol tIIiI penIIit. ud tIIcf.uJ iafona tIIeir
ClDDt:ractcn(I) ol the iDfozmadaa.
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Jane Leinberopr (F;MERGENCY VF.RRAT.\
(Apptic:ul (Paminee) JlliatlIip
~4/96
Nams: -AU. WORK SHALL CDNPORM wrIH 'IlIEA1TACfED. APPROVED PlANS AND ALLAPPIJCABU! CAMPBELL St'ANDAKD
DRAWlNGS.AND CONDmON5.
lHE COl'tlBACI'OR MUst' HAVE nus P!!RMIT AND APPROVED PlANS ATnIE sm!AND MUst' NO'IlPY 'I1D! PUBUC WOJUCS
DEPARTMENI' AT LEAST TWO DAYS BEPORE srAJmNG WOK
NanCE MUST BE GIVEN TO PUBUC WORES AT LEAST 2& HOURS BEfORE RPSI'AR11NO ANY WOK
SPEaAL PROVISIONS
_to
Sb'ecIIha1I DOC be apeD cut for 1IIIdct.........d .,.11....... MiaimUlll ems may be aIkIRd fell' \'lo...-1io. or aparatica ba6eL Sudl a1lI must -;::
be mecifiaJJv ~ bY tile ~ mim ta C'IItI:i:M. C
hvaDeat may be: cut for ~ ;......11.- ad __ be I'IlIIGI'Id ill ~duce wida tIae UdIity Treadt ReaD..... StudIrd J>rniDc.
Wort to be lUted by a UceIIIed 1.aDd &arw.,or or Civil P~P- aDd tIIU (2) capiII 01 tba ~ .... laC to 1M hbJiI: Wmi:I DepuuDcDt
before s&a.niDc wart. I '
Ufh Mf:1~1I1l'-t'U-.Nr:il ~510.U0r)(,~J~ cU&s /tf-~Jt:; C(J~A-cTpN rUfe ,..,.t:.T/.H)~ :AI.
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PERMIT APPUCA'nON PEE mD.m
PlAN alECK DEPOSIT ssnm
SURElY fOR PA1'llIPUL PERFORMANCE (1~ OP ENa. EST.)
CASH DEPOsrr (4" OF SURElY. :sm NJN)
PlAN alECK 4 INSPEC110N t"r.I:~(JIIRST>>S:JO~ 141J11;
Ncu $3O,OOO-SSO.CXlO 109&; AmouAl 1DUl)
APPROVED POR ISSUANCE v
for City
h:PW pERMIT IRev.4/94 (ue other aide)
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!rANDARD
AMOUNr
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* "SA nhone (800) 642-2444
TICKET NO_
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CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
)jWG
PROJECT NO. 9t-/cl. 4-
REPORT NO:
"Li'J r/.~.
CONTRACTOR: G.Jlt~
DATE: fl/o &
WEATHER: /c..;/
INSPECTOR: R. ~51fALL
ITEM
DES CRI Pl'ION
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