96-143
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./
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERMIT
(for working within the
public right~f-way)
Issued 3 ~ .u - f~ ~'r
Pennit expires in 12 mos.
Pennit No.
lC-Ref. File
96-143
ll>.
Application Date 3 / 2 7 / 9 6
Application expires in 6 mos.
APPUCATION - Application is hereby made for a Public Works Pennit in aa:ordauce with Campbell Municipal Code, Section 11.04. (Application
expires in 6 months if the pennit is not issued Application Fee is non-refundable).
A. Work address or tract #
Utility trench location
Winchester and Sunnyoaks
B. Nature of work
EMERGENCY MAIN REPAIR - 2'x2' cut in asphalt
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
Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by
the City Engineer, said plans become a part of this pennit.
D. All work shall confonn to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Pennit Conditions
listed on the reverse side; and the Special Provisions for this pcnnit, listed below. Failure to abide by these conditions and provisions may result in
job shut-down and/or forfeiture of Faithful Perfol1JW1Ce Sureties and cash deposits. (See General Pennit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HA VB TInS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORK.
Name of ApplicantlPenninee
San Jose Water Company
Yes
San Jose,
No
Tdqmone 279-7979
CA 95128
Address
Is this work being done by the property owner at their own residence?
1221 South Bascom Avenue,
The Applicant/Penninee hereby agrees by affixing their signature to this pennit 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 pcnnit.
The Applicant/Penninee hereby acknowledges that they have read and understand both the front and back of this pcnnit, and they will infonn their
conttactor(s) of the information:
3/27/96
Date
,.~.-
"""'f'
CITY OF CAMPBELL
)JWc-
PROJECT NO. 7't-/lf J
REPORT NO:
FIELD ENGINEER'S DAILY REPORT
ITEM
fM N/----et... (?;; o~k.s
DATE: 4 -10 -7'~
WEATHER: ;:;'; r
INSPECTOR: K. ~51fALL
CONTRACTOR: CUS),W/tVIr-<
DESCRIPTION
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PAGE: I
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