91-159
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a.
ern or CAIIPDLL
DZP1'. or PUBLIC WOIQtS
70 Horth Firat st.
CI'~ 11, CA !J~e=:;
(40') ..6-2150
pCROACHMmrr PERMrl'
(tor workillCJ in the
public ri_-ot-vay)
I.wed &=--{". ~ {
Pezait expu.. in 11 ....
Pemit 110. "I J - LS/
X-Ret. flle
AppucaUon Dab 8/ 13 /91
AppllcaUon expira 1ft 6 ....
APPLICA'1'%OH - Application u bereby _de tor a Public Wora Pemit in accordance vith eaapbell
lCUnicipal COde, section 11.04. (Application expu.. in 6 _ntIw it pum,t not pIllled)
A. Work ~ or tract .
Keith Drive & Valerie Lane
II.
Utllity 1:nncb location same as above
install utilities as per attached sketch SDE90597
lIature of work:
C.
Attacb five (5) copi_ ot a 4ravinq abovinq the location, extent and diaenaiona of the work
'!'be 4ravinq aball abov the relation of the propaaed work t:o exiatinq aurtace and underlJZ'OWld
iapraveaenta. When .pproved by the City Enqineer, aaid dr.vift9 beco8ea . part ot t:bU pu1Iit.
'!'be General COnditiona tor all permita are li.ted on the rlWerae aidtl. Spacial PrlWuiona tor
thi. pena,it an 118ted belovo rallure to abide by thea. c:ond.itiona and proviGiona -y reault
in job abut-down and/or torteiture ot Faithful PertoJ:1lllUlce IIonds and ca8b depo8ita. (S..
General ConcUt1ona 1 and 2).
D.
'!'b18 18 non-refundable.
~o(J I
408j725-2ff9-
z. An application t.. _t acca.pany t:bia application.
II... ot Applicant Pac ifi c Gas & El ectri c
AddrH. 10900 N. Blaney Ave.. Cuoertino
I. t:bia work beift9 done by the property owner at their own rHiance? ---:t- Lno
CoIIplete and .ttacb Worken' eoapena.tion and contractor Intoraation foma.
'falepbone:
'!'be Applicant/PerII1ttH bereby .qre_ by attixiIICJ their aiqnatu:n t:o thl8 -permit to bold the City
ot
CUlpbell, ita ottic.re, aqenta and .-ployeea tree, a.t. and banlea. f~ any claia or daand for
cSaaaq.. re.ultin9 troll work caverecl by thl8 permit.
at they have read .net uncIeratand both the front and
their con~ct:or(a) of the intoraation.
8/13/91
ACCZ1"fZD
Dat.
PIIDVED PLUS AlII) ALL APPLICABLE CAllPULL
1I0'l'ZS I ALL SBALL CONI'OlUI VI'1'Il 'l'BE A'l"tA
STAIIDAIlD DRAWIHGS AIID cmmrnOlCl.
'l'BE COIft'RAC'fOll IIUI'l' BAft '1'IIU PERIIIT AIID Al'ftOnD PIMB AlII) IIUB'l' Ma:r 1II'1'II 'l'BE P. W. DflPZC'1'OR 011
'I'D SITE It!Z LBAI'l' '1"110 laYS DI'OD BDJrl'DIG WOIIIt.
JfOTICZ MUST a GIVD '1'0 PUBLIC WORD It!Z LBU'1' 24 HODRI aroa RZS'rAIlTDG AllY 1IOII1t.
SP!:CYAL PROV:[S!OlfS
-Ll.
street aball not be open cat: for underqround inatall.t1ona. II1nlaua cuta -y be alloved
tor connec:t:iona or exploration bol... SueIl cuta !met be eDeCirieallv aDDroYe bY the
In~Dr.
paveaent MY be cat: for anderqrounc! inatallat:1ona and .uIt: be reat:oncl in accordance vith
the Ot:i1ity Trencb ~ration Stanc:lard Drav1ft9.
Work t:o be ataked by . licenaed Land surveyor or Civil Dl9ineer and two (2) cap1_ ot the
cat: abHta aent: t:o the Public Work Deptartaent: betore at:artinlJ work.
'l'be boun of work an l1Ja1t:ed t:o cutaicSe the boura of 7-' .... and 3... p... for any work
att.ct:1DcJ . traff1c 1..... h 1 k' h . f b 11
T e on v wor_ ln r, e c'ltV 0 Camo e
is at McCoy and Weston. There is no trenching planned
within the public right-of-way at that location
_2.
_3.
_4.
-L5.
,._1.,
S'l'1Mn1RD
UIOtJtft'
105.00
U~!P'l' ~
Q
PZIUIIT APPLICA'tIOII n:z ($50.00)
PLM CDCIt DUOI1'1'
IOIID FOR rAI'l'Hl'tJL PDI'ORJWICZ
CASH DEPOSIT ($200.00)
PLAN CDCIt , IIISPEC'1'IOH rzz
'100,000 - '500,000 ",.
APPROVED FOR ISSUAIICZ
'100.00
'500.00
(100' or IRQ. 1ST.)
(4' or BGIID, '500 KIM)
.
.
.
.
.
105.00
Q
~".,~ -~L
. Date
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