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CITY or C^~F ELL
D~?T. or PJB IC ~ORKS
70 ~orth f1r t St.
Ce~~~ell. C^ 95008
(40t) 8c6-2l50
No. 81.~l d..
~
PUS Ie ~~Rrs PER~IT
lID ~or~l~g 1n tne
p.:~ ic right'-of-...ay) X-i<et. file
IES~ed 8. 2;1: ~~ Ipplicat 10n Date 8-17-87
Perll,lt ell-'ue 1r, ~DS. ~xpiree 1n e "'os.
~ede for a Public ~orks Per~it In accordance ~ith Ca~pbel~
Pers:i t
C'
~
(
^??~IC^710N ~ Application Is hereby
~~nlclpal Cooe, Sectlon 11.04.
-,
A.
I
900 E. Hamilton Ave. Camp.
r
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Work address or tract t
Utility trench location
B. "ature of ""orlt: Install utilities as indicated on the attached sketch. SDfi 41G38906
C. Attach five (5) copies of a drA~ln9 sho~ing the location, extent and di~ensions of the ""ork
The dra~in9 &hall 5ho~ the relation of the proposeo ""erk to existing surface and underground
improvements. When approved by the City Engineer, SAid dra~in9 becomes a part of this perrrlt.
O. The GenerAl Conditions for all per~its are listed on the reverse side. Special Provisio~s for
this permit are listed belo~. failure te atlde by these cenditions and provisions ~av result
In job shut-do~n and/or forfeiture of faithful Performance Bonds and cash deposits. 1See
General Conditions 1 and 2).
t
;
E. An application fee m~st
Na;r,e of ,l.pplicant Pacific
Adoress 10900 N. Blaney
acco~pany this application.
Gas & Electric
'!'td s i E
nOi"1-rt-~u:;da=>le.
973-8930
:
'Telephone:
Ave.
Cupertino CA 95014
Is this ~ork being done by toe property o~ner at their o~n residence? ___yes no
Complete attached "or~er." Co:pensAtior. and Contracter for~i.
The A?plicant/Per~ittfe hereby agrees by affi~ing their signature to thi. per~it to hold the City of
Campbell, Its officers, agents and e~plo:ees free, 5efe ano har~less frorr any clai: or deruand for
darr.eges resulting fron, the work covere~ by this permit.
Tne ~?plicant/Perrnittee
back of this permit, e
ACCEPTED David
A~D AL~ AP?LICkELE CA~?B~L~
read and understand both the front and
torls) of the information.
August 18, 1987
,",c~E
NOTES: ALL W~?r. SHALL CONPOR~ WITH THE ATTACH~O,
STANDkRD O^^~INGS AND CON~ITI0NS.
'THE cOSr~ACTvR ~JST HAVE THIS ?~~~IT AND k?PROVED PLANS AND ~UST ~EET ~ITf. THE P.W. !~?E~~R o~
TEE SITE ~: LEAST T"D D^~S BE PORE ST~~:I~G ~DRK.
NOrlCE ~JSr EE GIVE~ TO PJS~JC WORKS ^! LE^S! 24 HOURS BEfORE ~ES:AR7~~G kN)' ~ORK.
S?~CIAL PROVISIONS
/1.
Street shell not be open cut for u~dercround installations. ~i~im~~ cuts ffiay be ello~ed
for connections or explor~tion holes. 'Such cuts must be speci!lcally approved by the
Ir;sDector.
rc~~~enr mey be cut for underground installetions end ~~st be restored in bccor~~nce ~it~
the Utility Trench Restoration Standard Dra~ing.
~ork to be staked by e license~ Land Surveyor or Civil Engineer en~ t~o (21 co?!e! of t~e
c~: ,heets sent to the Pu~Jic Work Dept. before sterting ~ork.
The hours of ~ork are limited to outelde the hours of 7-9 a.m. and 3-6 p.~. for a~y wor~
effe~tinc a traffic lane.
.,t. ,..1/ blF,Jl.C.! "'HJ~ bv /ovP"-t.,/ t?fA+.fM D + ~_ .;.J'L"'''tnlk Qr"lAU
b. Nt> ~ l,w,si--h "'rt/'1lrTN..d...v,;H,,~) /It'........'1.
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S';^NDAF.D
MQUNT
RECEI?'1 NO.
W
PER~!T APPLICATIOh PEE
$ Sf? 0 D
$
$
($3~.OD) S50.00
$500.00
(lOo, Of ~NG. EST.)
PL.v< Cerci DEPOSIT
B~ND PO~ fA!THfUL PERPO?~~~CE
P. P. lC^SE) DEPOSlT ($200) (H OF BON~,$500 ION)
.r~);..;> tw, "'(hr~ ,(Jf!
F[;.,1'i11 PEl.. ;t. (7\ Of f..P, B:JND
'--:rvJ/)',~_ j ,;J, R. I . d _~ 3 ~ ~~ 1'.: N )
^P?ROVC~ POR lSS~^NCC ~~ ~
$ -
$ I ~t-f ,S- {/
~
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g/:z I / ~ 7
( 1 ",~:e
f: p,..'?!:i<",J1
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