96-146
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 37~58
ENCROACHMENT PERMIT
(for working within the
oubli< ritJrt-<>f-"'Y)~8
Is~4///Cj0 0
Pcnnit eXpires in 12 mos.
'ilermit No.
.~-Rcf. File
96-146
~
Application Date 4/1/96
Application expires in 6 mos.
APPliCATION - Application is hereby made for a Public Works Pennit in aa:ordance with Campbell Municipal Code, Section 11.04. (Application
expires in 6 months if the pcnnit is not issued Application Fcc is non-refundable).
A. Work address or tract # San Tomas Aquino Road 100' south of Campbell Avenue
Utility trench location
B. Nature of work
4' X 6' cut in asphalt for emergency gas leak repair
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 pan of this pcnnit.
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 pennit, listed below. Failure to abide by these conditions and provisions may result in
job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Pennit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HAVE TInS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBliC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBliC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORK..
Name of ApplicantIPennittee
PG&E (Julie)
Telephone
725-2176
Address 10900 N. Blaney Ave., Cupertino 95014
Is this work being done by the property owner at their own residence?
Yes
X No
The ApplicantlPennittee hereby agrees by affixing their signature to this pennit to hold the City of Campbell, its officers, agents and employees free,
safe and harmless from any claim or demand for damages resulting from the work covered by this pennit.
The ApplicantlPennittee hereby acknowledges that they have read and understand both the front and back of this pennit, and they will infonn their
contractor(s) of the information:
Julie (emergency verbal)
(ApplicantIPennittee) print/sign
4/1/96
Date
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. CITY OF CAMPBELL
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PROJECT NO. 9{' /4&
REPORT NO:
FIELD ENGINEER'S DAILY REPORT
DATE: t;~/rJ -1&
WEATHER: h)/"
INSPECTOR: K. .ve:SrfALL
ITEM
DES CRI Pl'ION
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CITY OF CAMPBELL
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CONTRACTOR: fJ6~
PROJECT NO. b/
REPORT NO: I
DATE: 4 ' / - ? 10
FIELD ENGINEER'S DAILY REPORT
WEATHER: ,
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INSPECTOR: K. .ve:.51fALL
ITEM
DES CRI Pl'ION
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