91-103
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c:rn OF <:AHPBzLt,
DEPT. OF PUBLIC WORJal
70 N~ F!zwe Se.
ca.pba1l, CA 95001
(.&01) 1&&-2150
C;J / -/t.'-.::~
ENCROA~ PERMT'I'
(for worJtinq in the
public ri9bC-of~y) X-Ref. tile
x__ed 1/9/ tJ / AppUcaUon Daa ,/ '7/9>
PeEllie expu.. 111 12 _. App11caUon apu. 11'1 6 ....
APPLIeA'l'tOH - Applicaeion i. hereby _d. tor a Public Wora Per1U.e in accordance with ca.pbeJ.l
Municipal COda, Saeeion 11.04. (Appl1cation apu.. in 6 .:antba if paJ:1lit not pulled)
PHait Ho.
A. Work addru. or tract .
1J1:ll11:y 1:rencb locaUon
B. .a~ of workr
1253 A Harriet Avenue
install utilities as shown on the attached sketch.
r,OOL.10
c. Attach fiva (!I) copi_ ot a clrawinlJ .bowinlJ tha locaUon, extant and diaanaiona ot tha work
'!'ba clravinlJ &ball abow tha ~laUon ot tha proposed work to axistinlJ .urtace and IIDdarqround
iaprovUlante. Wban approved by the City EnlJineer, said dravinlJ be=-- a part ot th1a pumt.
D. '!'be Genar1ll COnditiona tor all panlite are listed on the r.verae aide. Spacial Provisions tor
this panait are listed below. Failure to abida by these conditions and provisions _y ~.ult
in job abut-down and/or forfaiture ot Faithful Partonaance Bonds and casb deposita. (8_
General COncUtiona 1 and 2).
B. All application t_ ast aCCOllp&n)' this application. '!'b1s is non-rafundabla.
N... of Appl1cant Pacific Gas & Electric 'l'alapbonar 725-2114
Add~s
l(}q(}(} N Rlanev Avenlle. Ctlpertino.. ~A Qt;OlLa.
Is thi. work bein9 dona by the property owner at thair own ~idanca? --Y- _no
COIIplata and attacb Borkan' caapansation and COntractor Intonaation tonaa.
'!'be Appl1cant/PenaJ.tt_ baraby aCJra- by affixinlJ thair .iqnatura to this-panlit to bole! the City
ot
OUIpbell, it. officara, alJanta and aaployee. f~, ..te and barala.. fJ:'Oll any claia or daand tor
daaaq_ ra.u1tinv tZ'Oll the work covarad by this paJ:1lit.
owledqe. t:hat they hava ~ad and undentand both the front and
intona thair contractol'(.. ot the infonaation.
Data
l')/')F,/QO
msh/sr
HO'l'BSr ALL 1108 SIIALL COHl'ORK 1fI'1'B '1'BE AftAaIED, APPROVBD PLAlrS AIID ALL APPLICABLE CAllPBELL
STANDARD DRAWIHGS AND COHDI'nOllS.
'1"D COlft'RAC'l'OJl MUST RAft 'l'IIU PBIlIII'1' AND APPIludD PIMS AND IIUS'l' IID'l' 1II'1'II '1"D P.W. IIfSPBC'rOR OM
'l'IIB Sm: H LEU'1' '1'WO laY. 8D'OD S'DRrIIIG 1IOIIJt.
HO'nCB MUST D G:rva '1'0 PUBLIC WORD H LEU'1' 24 IIOOItS UI'OD RB8'l'AIl'nJIa AllY 1IORlt.
g~eyAL PIlOVYSYDIIII
_1.
street &ball nlrt be open ~ for unclarqrouDd installaUcms. lliniaua cute _y be allowed
for connactiona or exploration bol_. SUcb cute _.e be .aecifical1v aDDroved bv t:he
Inll'Dae'tltr .
PavDaftt _y be cut for WIClarqrouncl inatallationa and -.t be natorlld ill accordaDc:e with
the 1J1:llity 'l'ranch Raatoration Standard DravinCJ.
Work to be ataJtad by . licen.ed x.nd suneyol' or civil BnlJinaar and two (2) copi_ of the
cut ab_te sant to the Public Work Daptart:llant: befg~ lI1:artinlJ work.
'!'ba boura of work are 11a1tad to outside the boura of 7-9 .... and 3... p... tor any work
.ffectin; a traffic lane.
~./2.
_3.
_4.
-'.
'11-1 ,
S'!'1lmAIU)
R~YPl' NO.
AMaDR'P
PBIUIIT APPLIeA'l'IOM I'D
PLM ama DBPCISI'l'
$100.00
'!I00.00
. \a>e.oCO
.
.
S
. \ct.?, (6
Cf
\ - 9 -~ )
Data
Cf
(S50.00)
BOND FOR FAITBI'CI. PDFOlUWICB (100' OF aG. 1S'l'.)
CASB DBPOSI'l' (UOO.OO) (4t OF BOJID, '500 KIlf)
PLM ama , INSPECTION I'D ('0 - $100,000 10"
$100,000 - $500,000 ", '~'OOO and. 7', '100 KIN)
APPROVED FOR ISstJUCB _~
for Ci . ea
(SEE 0DI!ll SIlE)
.~
'il:
CITY
OF
CAMPI1E.LL
PER.MIT SJ<~rLH
~
/4\600430
MAP :!41J'Ab
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IN .s I ALL 5 J' 0 F II z.:.' PL.:' S T IL\...I! ., i1
1/4' 1\.\ . C. . r.. i : u: .
[... Tr.:E.NC.I~ I; JI..,...T
wlH" 6/.\~) E.U.<.r. iE:l-(u
APr'lICA,...T TO TR.E.IJ(..11 ON
PeS t.l ru rr_E.'" (.11
A l ~ 0 'TO ( r.J j \ A L "-
I'" r:lJT\JIt~ PAr..K
r.,l, D
J ,iE
Df:.(- .s,n:.
^ \i" X .30/1
IT''-iP.
LI'I-TV.
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1'"6:(
e. LJ >'
..
P.,PPROVED FOR COr'..jSTRUCTION.
City of Carnpbell
Public Works Permit No. C}I -/ ti3
(ontractor mus' have these plans
on the iob site during construction.
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