96-129
arY OP CAMPBELL
DEFI'. Of PUBUC WORICS
'70 North Fait St.
Campbdl. CA 9S(OJ
(0) ~2150
ENCROAOIMPNI' PERMrr
(for worma witbiD tbe
public . t4""')
10
PenBit ClIJlU- ill
~c~t No. 40--/29
X-Ilef. file
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APPUCAnON - AppIic:atioa iI bcreby .. lor. Public Warb PenBit ill accclIdaDce witb r__."..... M1IIIicipaI Code, Sectioa 1UN. (Appliclitioa apinI
ill 6 IDDDdII if tbe pcnait ilDOt iIIued).
A. Wort addteII or tract #
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Utility tnDdIlocatioa ~<:--
B. Nature ohort f & PiJ-Jl<-
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C. Anacb four (4) eopia 01 aD cqiDecred dnwiaa IIaoIriq tbe Ioc:aIioD, ateDt aDd "'illleui~ 01 tile wart. Tbc dnwiaa 1baII__ tile RIatioD 01 tbe
JII'OIlCIICd wort to CIiIa:iq IUJfKe aDd UDdcrpouDd iaaprovaDeDlL Wbca appro.ed by tbe aty P~&i-, laid dnwiaa becaDea . put 01 tbiI pcnDiL
D. AD wort IbaII coaform to tbe Oty'1 GeDeJII ~ Stadud ec.tructioa ProMc.. aDd StaDdud ~ DeWII for PubIie Worb
CoaItructioa; tbe GeDeral Permit Cooditioalliaed OIl tbe JeVaIC aide; aDd tbe Special ProMc.. for tbiI penDit, Iiaed..... ..... to Ibidc by
tbae CIOIIdit:ioal ad proviIioaIlIIaY rault ia job lbut4Jn ad/or forfeiture 01 faitbfuJ PafonDaDcc Sureac. ad CMb dcpoIilL (See GeDeJII
Permit Coadit:ioall aDd 2.)
E. A DOIU'CfuDdablc applic:atiOD fee mUll'" ....,..,. tbillIfIIIIicatiOIl
Name of Applicant W&-ST VA-JlbY JlJ--jV I ~hu,v
AddraI Ja 0 b S LI Nf'J Y OA-/c..s fl-V~
Tek:pjK1ot 3 "} f -;) 'f [) 7
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Is tbiI wort beiDI doae by tbe property OWDer at tbcir on ftIidcDce?
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Ya ^ No
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Compiete aDd attach Worton' Com~_tiOD ad CoIltnctor lDformatioa fonD&.
The ApplicantfPorminee bereby ..,.. by atfixiJIa tbcir Iipahare to tbiI pcnait to bold tbe aty 01 r....,,-ll. ill oftiecn., ..... .... ...,.~ fne, _0
ad barmlea from any claim or dcmaDd for damap raultiq from tbe wort ClMIed by tbiI permiL
The AppIicaDtfPerminec bereby ackDowlcdp:l abat tbey baft read aDd UDdcrItaDd botb tbe froat aDd bKk 01 tbiI permit, aDd tbey will iDform tbeir
caatr'llCtor(s) of tile illformatioD.
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(Applicant (permincc)
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N01l:.S: AlL WORK. SHAU. CONFORM wrrn 1HE AlTACIED, APPROVED PlANS AND ALL APPUCABLE CAMPBELL STANDARD
DRAWINGS AND CONDmONS.
1HE CONTRACI'OR MUST HA VB nus PERMIT AND APPROVED PLANS AT 1HE srre AND MUST N011PY 1HE PUBUC WORKS
DEPARTMENT AT L.EAsr TWO DAYS BEPORE STARTING WORK.
NonCE MUST BE GIVEN TO PUBUC WORKS AT 1.EAST 24 HOURS BEFORE RFSJ'ARTING ANY WORK.
SPECIAL PROVISIONS
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Street IbaII DOt be opca cut for UDdcrpouacl iDItalIatiODl. MiDiIIlUlll CUll ....,. be aIIoMld lor ~ or apkntiOD boIeL SudI c:utI JII!!S
be IIlCCificalIv amlI'OIIed by tile Inmector Mior to cuniD2.
hvaDeDt IIlllY be cut for UDdcIJl'OUDd iIlItalIatiOlllaDd mUll be ratonld ill accclIdaDce with tbe Utility Tracb ~ Stadud I>mriD&-
Wort to be aaked by a liccDlOd 1.aDd s.uw,or or CYil &pDeer ad two (1) copies 01 die cut MeelllCDt to tbe Public Warb DepuuDeltt
before Itar'tiD& work.
~OW€'i..- ~~ Clute. ~ ~ '!;.~f ~M ,tG;c)u../hJJ~ iASf: 'f~ 4AcK-I~/iL- I;: A c..
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APPROVED POR1SSUANCE
SZlo.oo
SSOO.OO
(1~ Of ENG. ESI'.)
(4* Of SURErY. SSOO MIN)
$0-$30,000 14%;
7%, 1IliD)
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STANDARD
AMOtJNl'
RFrPJPT NO.
PERMIT APPUCAnON PEE
PLAN amcx DEPOSIT
SURmY POR PA.I11IPUL PERFORMANCE
CASH DEPOSIT
PlAN amcx .t INSPECl10N
Next $30,000-$80,000 10%;
Q
* *
b:PW PERMIT /Rev.4/94
USA phone (800) 642-2444
(Ice other side)
TICKET NO.
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