91-126
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DZP'1'. OP PUBUC: WORKS
70 North P!r.t St.
ca.pbe1l, CA '5001
(401) U--.2150
'tr
,..-l" /'1' .~ E
Pem!; 1I0:-+-- 9/ -/--2 t~
DlCROACJDmH'!' PERMYT
(tor workinq in the
public ri~~f_.Y)
I..ued A / ~/
Pendt expu.. 12 _.
X-Ref. file
Application Date 3;/ /91
AppJ.icaUon exp1re8 in 6 ~a.
APPLICA'l'rOM - Application 18 bereby ..d. tor a Public Worb Pera1t in accordance with ca.pbell
lhIIlicipaJ. c:ocle, Section 11.04. (ApplicaUon expu.. in , ..,ntba if' penlit not pulled)
A.
Work ~. or tract t Harriet Avef.1ue @ Roebnick Court, Campbell
UUlity t.nncb location
.a~ of work I Instal 1 utilities as indicated on attached sketch (SD#G/E10485)
B.
Attach five (5) copi_ of a drawin9 abovin9 the location, extent and diaenaiona of th. work
'l'b. drawincJ aball mow th. relation at th. propo.ed work to exiltincJ lurtace and undarqround
iJlpraveaente. When approved by the City !D9in..., aaid drawincJ bec~. a part of tIWI penlit.
'l'ba General COncUtiona for all permits are a.ted on tha revarea aida. Special Proviaiona tor
thb perait are l18ted belovo Pailure to abide by th... condit1ona and prov18iona _y reaul.t
in job ahut-dovn and/or forf.iture of Paithful. Performance Banda and C&8b d.po.ite. (S..
General Conditiona 1 and 2).
Z. An application f.. ...t accaapany tbi. application. '1'bi. 18 non-refundabl..
N_ of Applicant Pacific Gas and Electric ComDanv '1'e1.epbone: 725-2114
Add~. 10900 N. Blaney Avenue, Cupertino, CA 95014
C.
D.
II tbi. work beincJ don. by th. property owner at their own ~idance7 --:1" _no
COlaplete and attach Worar.' COIIpen8ation and COntractor InfoZ1lation foZ1la.
'1'b. Applicant/Pen.1ttH bereby atJree8 by atfix1n9 their 819ft&t1Ire to thb "perJlit to bold the City
of .
Campbell, ita otfic.re, a9ents and .-ploy.e. tree, ..t. and banl.... t;'Oll any claia or cSaancS tor
~q- rHuJ.tinV fro. the work CGYered by thi. penlit.
'1'be Appiicant/P.naittee bereby acJtnovledq.a that they bave read and understand both th. front and
back of thb pe and, tbat th will infona their contractor(.) of the infoZ1lation.
2/25/91
A~C
Dat.
'1'IIZ c:otn'RAC'1'OR IIU8'1' RAft '1'B18 PDIIIT AND APPrwVBD PLUS ARD IIIJB'1' IIEft Wl'tII '1'IIZ P... InPZC'1'Oll OK
'1'D SI'l'Z H LZUT '1'110 laY. DI'OD SDRrDIG IIOJIK.
RO'l'ICZ IID8'r .. GIVD '!'O PUBLIC WORD H LZU'l' 24 IIOUJII uroa DI'1'AIl'nJIG AllY 1IUU.
SPECYAL PROVYSrORII
_1.
Street 8ball not. be open cut for undar;roUDd inatallaUona. 1Iin~ cu1:8 _y be allowed
for connectiona or exploreUon bol... Such cuta .aft be aaeeificallv aaaroved bv the
rn~~~.
pavaent _y be cat for anderqraund inatallaUona and -.at be re8torecl 1ft accorclanc:a with
th. Ot.ility Trench Re8torstion Standard DrawinlJ.
Work to be .taked by a licen.ed LaDd sun.yor or Civil Bn91neer and two (2) copi_ of the
cat abaete .ant to the Public Work Daptartaent bef~re atartin9 work.
'1'b. houn of work are liaited to outaida the boun of 7-' .... aftll 3-6 p... for aay work
affac:tiDIJ a traffic lana. . 1 ' .....,,? A..... . .
.A Af4;.JUh';./ ~AFe 'rldo t-.P9'-7' ~bbe;77'l.MJ.J9 v&H/{.Ul.A"',e /"-Hrr/{. A,AU 77~
/ / ,
g. rL4GI'11.4~/""'o.J /EEtpu,'lt-€Z>
I'~. I?J.AvlGP/"L 1'02. C;'T'-I -S7i1I...IL:}A/t,.... r:..~~ Jll-n;r:/C4El:::J \
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~NnARD
H~t:Pl' NO..
AMamI'P
PZlUII'1' APPLICA'l'IOK rD
PIAIf CllZCK DIJI081'1'
BORD lOR !'AI'I'UDL PDl'OJUWICZ
CASB DZPOS1'1'
PIAIf alECK , IHSPEC'l'IOK FD
'100,000 - '500,000 ", '50
APPROVED FOR ISSDANCZ
$100.00
$500.00
(100' OF EHG. ZIT.)
(UOo.OO) (4' OP BOIID, $500 lID)
('0 - $100,000 10"
and above n $100 lID)
$ /t/~. ~V
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(UO.OO)
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