91-108
::; ; .. "0
"' "
. . n "
.
C II
; f :. ~
..
) :;. ~ g
, oc:
>>
:> t 5 ...
:> N
~ .. ..
...
-~ 0
~ I ...
~ ft ..
. ':J'
,... .. " .
~ -..
!"S'
:: i ! ~
.,
~ " ~ i
~
.. ~ ..
-
0: ... n n
, ;;- It l
.
...
. ~
.. ..
" ':J'
. ., ;-
~ ..
-1:1
: ~ .
. ... -
..
I ':J'
. ;-
.
! i ~
.. ! ..
. c
., ! .
!...=
':J' ::a.
. -. ...
" l!. ~
.
! ~
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 Nor~h Firs~ St.
Campbell, CA 95008
(408) 866-2150
ENCROACHMENT PERMIT
(for working in the
public right-of- ay)
penit No.
if I - I olf1
X-Ret. file
Application Date I Ii 7/l!J
Application expires in 6 mos.
APPLICATION - Application is hereby made tor a Public Works penit in accordance with Campbell
Municipal Code, Section 11.04. (Application expire. in 6 months it permit not pulled)
A.
1C?4- R~ L-/97'JL-
d~ ~;vJAFZ-1 1;:;.-'73' ~C?
~~-r/~ 94: /9/C:- ~
,
(.A.J/~C
-r,,::rp ~t...C.-
Work address or tract ,
Utility trench location
B.
Nature of work:
C.
Attach five (5) copies ot a drawing showing the location, extent and diaensions of the work
The drawing shall show the relation of the proposed work to existing surtace and underground
improvements. When approved by the City Engineer, said drawing becoa.a a part ot this permit.
The General Conditions for all peraits are listed on the reverse side. Special Provisions for
this permit are listed below. Failure to abide by these conditions and provisions may result
in job shut-down and/or torfeiture ot Faithful Perforaance Bonds and cash deposits. (See
General Conditions 1 and 2).
D.
E.
An application te. must accompany this application.
P& ~6-
This is non-refundable.
Address
'3~
~~
-?~
Telephone:
...J &7?~
Name of Applicant
~E-
Is this work being done by the property owner at their own residence?
/<no
---yes
Complete and attach Workers' Compensation and Contractor Information toras.
The Applicant/Permittee hereby agrees by affixing their
of
Campbell, its officers, agents and employees free, safe
damages resulting from the work covered by this permit.
signature to this penit to hold the City
and hanless troa any claim or demand for
The Applicant/Permittee hereby
back of this permit nd th t
acknowledges that they have read and understand both the front
will inform their contractor(s) of the information.
/-/(P-q I
and
ACCEPTED
ign
Date
~J
'.JI .~
"'- )")
... .1)
..... ..~
:"-....
INSPECTOR fill
~
."
-
Applican
NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W.
THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECI~L PROVISIONS
_____1. Street shall not be open cut for underground installations. Miniaum cuts may be allowed
for connections or exploration holes. Such cuts must be sDecificallv aDDroved bv the
Insoect:or.
~. Pavement: may be cut for underground installations and must be restored in accordance with
the Utility Trench Restoration Standard Drawing.
_____3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the
cut sheets sent to the Public Work Deptartment before starting work.
4. The hours of work are limited to outside the hours ot 7-9 a.a. and 3-6 p.m. tor any work
affec;.ting a traffic lane. . J . . ..
~5. 1l1A?4/,v77t:17d ~ T1..rk/ ~ iJ67)G37iU~fP V~#/(,4Uff( "ntAPP'/(; R1"' .4L.'t., 77~
y /'
~ C/-I/o ~4'L ~'",.,;/~4.€2> A", < .
I
CR-l1
STANDARD AMOUNT
$100.00 $ /CO,CD
$500.00 $
(100\ OF ENG. EST. ) $ ,---
(4\ OF BONO, $500 MIN) $ ----
$ / ()If) . OD
RECEIPT NO.
6)__
PERMIT APPLICATION FEE ($50.00)
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
...---
CASH DEPOSIT ($200.00)
9 ~.
/h~~;;
/ 0 e
APPROVED FOR ISSUANCE
PLAN CHECK , INSPECTION FEE
$100,000 - $500,000 9\; $500
t: PWPERMIT
Rev:sed 7/,,0
.1
I
1
1
I
I
I
I
I
I
t-3
o
tp
tI:l
()
o
3:
't1
t"'
tI:l
>-3
tI:l
o
to
~
~
't1
't1
t"'
H
()
~
Z
>-3
I
I
I
I
I
I
I
I
'"-i
.">-
""-
<Q::
--:;
l
i
.S
i
~~
~I
oIJl
ell
I
>-3
o
tp
tI:l
()
o
:3:
't1
t"'
tI:l
>-3
tI:l
o
tp
to<
()
H
>-3
to<
I
I
I
I
I
I
I
I
I
I
I
I
5U!J80U!bU3/IJIJOM :)!Iq"d
, .... ,~ l ) T "J \,.J ".
l ::C': '. ~ '. v I
"'!Ali:)11
-0
c
rr
-
(")
<:
..~
o!:~....""
o
... .~)
g -, ;~'{-..
;
.::. ,J
~ ;';"
5' r,' -....
3'" '-?
'"" .-
...~ :J
1) ~
"- - -
';:T' >. ~
~. Q
::J -:
..a rc ...-f"
" -
~;r ~......
~ ~
t '0
~' ~
i'\
-........'
,~
!
\
--......-.
C',
\:~
..---.-
~ 10- I
S ~ \). Ij I
~-i~ _L,- '"" e~1L
) 'U ~!~ I~~ I
I ~ ~-i
I 1\ I
2.... -572-. H,p "'-
~ ~ ~.
-.-,-f- Ro~/V1A~rL LN-:-
}>(
T,
......
..-"
I I
\.
, : <<-
,
~."\ ~
~~ ~
(1 .
"-"
-.
f(:,:'.
~~
....
~N
~\
~:t
-~
\\J
"'-
~.;b
: \'. '~
I \ ~r '.
~ 1.
""''-
,
'\",
",
"" '\
" "'" ~ '. \'.
~~,~
"t\ "\, ""
~ .... '
,
" " ''-''-.
, "'~ .
'" \.....,
''''"', ""
",
-
~
"
,
"
,
" "-
" "
"'" '"
'" "
I I""'" ' I
~ ~~ ~'~~ ~~.." ~ I
f -~ ~~~ ~~~' I
~~r-P1 ~ I
~ c l I)-
~ ,~. ~ ~ e ~ \, L
~~ ~~~ \
~ L C ~ ,j ~ II ~
~ ~ ~ ~ II
~~H ~~ f li~
t. : ~ ~ ~
)> )> z n
3: z CIl )>
"'tl 0 -I -4
0 )> J:
." m r- 0
::j .. r C
-4 (") n
)>
z Z -I "'tl
c;) 0 :I: ::JJ
en z 0 0
~o
z ) n -4
m
en '~ n
-4
)> :xl -f
0 0
r- , ~
r- Z
m ~ (')
0 )> -I
)> C) 0
-4 Z
0
0 -<
Z m
0 N CIl
Z Z 0
m (")
0
0 Z
::D ~)
CIl
m
::D
:-;
LJ
-l
en m
;:ll: m r
m aJ
-4
n
:r: 0
0 r )>
-I
:I: 0 Z
m 0 0
::D :!: 0
m
::D
~ m 0
C
CIl
-l
CIl (")
::r ~
0 --)>
:!: I~ z
0 !='
2 ~
CIl ~
^
m "'"
-l -1m
(') ~~
~
~ ::D
)> CIl
- m
~~
<
)>
r
<
m
0