91-120
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crn OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North Firat St.
ca.pbell, CA 95008
(408) 866-2150
Penlit No. 91-120
X-Ref. file
Application Date 2/21/91
Applicat:ion expir.. in 6 lIOa.
ENCROACHMENT PEJlMYT
(for working in the
public riqbt-of-vay)
IallUed ,.J/;) / , ~
Permit: expiru 110..
APPLICA'1'1:0N - Application 18 bereby ..de for a Public Wora Pendt in accordance with CUlpbell
Municipal COd., Section 11.04. (Application expiru in 6 IIOntb8 if perm.t not pulled)
A. Work addreaa or tract t 225 ROSEMARY LN. (cross street - Eden
Utility 1:rench location
s. .at:ure of work: Emergency main repair
c. Attach fiVe (5) copi_ of a drawinq abowinq th. location, extent and d.f.JD.naiona of the work
'l'be drawinq ahall abow the relation of the propoaed work to exiatinq aartace and und.rqround
lapraveaenta. When approved by the City Enqineer, aaid ctrawinq be=-- a part of th1a penlit.
D. 'l'be General Conditiona tor all permita are liated on the revere. aide. Special Provi.iona tor
thia permit are liated below. Failure to abide by theae conditiona and prov18iona _y reault
in job abut-down and/or tort.iture at Faithful Pertormanc. Banda and caab depoaita. (S.e
General ccmdi tiona 1 and 2).
z. An application tee :mat aCCCDlpany thia application. 'l'bia 18 non-retundable.
If... at Applicant: San Jose Water Co.
~rua 1221 S. Bascom Avenue, San Jose, CA
I. th1a work beinq don. by the property owner at their own re.idence? --y- _no
'l'elepbon.: 279-7825
95128
COmplete and attach WorJeera' C01IIpenaation and COntractor Information tOrJla.
'l'b. Applicant/PermUtee bereby aqre_ by affixinq their aiqnature to th1a-penlit to bold the City
of
Campbell, ita ofticera, aqenta and ..ployeea tree, aafe and baraleaa f~ any cla.f.JD or d..-nd for
dauq.. re.ult1nq from tbe work covered by thia permit:.
'l'be Applicant/Penlittee bereby acknowledqea that they bav. read and underatand both the front and
back of th1a permit, and that they will infonl their contractor(a) at the infonlation.
AC~ Jan - emergency permit 2/21/91
Applicant (P.rmitt_) print/81qn Date
NOTES: ALL WORK SHALL COJlPORH 1fITB 'l'BE ATTACHED, APPROVED PUBS AIID ALL APPLICABLE CAMPBELL
STANDARD DRAWIJlas AIID COJIDI'l'IOJIS.
'1'BZ CONTRAC'l'OR HUST HAVE 'l'IaS PZRHIT AND APPROVED PUBS AIID MUST JIEZ'1' 1fITB 'l'BE P.W. DfSPEC'l'OR OR
'l'BE SID AT LEAST '1'WO DAYS BBPORZ S'rARTDlG WORK.
NOTICE HUST BE GnrzH '1'0 PDBLIC WORKS AT LEAST 24 HOURS BEFORE RZSTAR'l'DfG AJIY WORK.
SPECrAL PROVISrONS
_1.
Street aball not be open cut for underqround inatallationa. 1Iin.f.JDua cuta ..y be allowed
for connectiona or exploration bola. Such cut. JllUat be BlHlciticallv aDDroved bv th.
In.Deeter.
P.v_ent _y be cut for und.rqround inatallationa and auat be rutored in .ccordance with
the Utility 'l'I'ench Rutoration Standard Drawinq.
Work to be ataked by . l1cenaed Land surveyor or civil Enqineer and bra (2) copi.. of the
cut abe.ta aent to the Public Work Deptartment before atartinq work.
'l'be boura at work are liaited to outaide the houra of 7-9 .... and 3-' p... for any work
.ffectinq a traffic lane.
v-Z.
_3.
_4.
_5.
(R-ll
S'l'ANDARD
REeEYPr 1m.
AHOtJIn'
PERKI'1' APPLICA'1'1:OJI 1"EZ
PUB alBa DEPOSIT
BORD FOR FAI'1'BI'tJL PERFORHAHCE
CASH DEPOSIT ($200.00)
$ \ CC::;I . CCJ
$
.
$
. 'LX? co
cy
~
($50.00)
$100.00
$500.00
(loot OF ERG. EST.)
(4t OF BOJID, $500 MIJI)
PUB alBa , DfSPECTIOJI FEZ (SO - $100,000 lOt,
$100,000 - $500,000 9', ,,00,000 and,~~7t' $100 MIJI)
APPROVED FOR ISSUANCE ~,.(.~_~~~
for C1t i er ~
(SEE OIHER SIIE)
2--2...1-~ \
Dat.