91-165
0
z
..
'10 ..
. ~
c: u
- t-
O
.
.. 0#
.. ..
.J1l ..
~ N
.
_ N
-;&
~
i '"
0
~
....
5 ~
-
.. ~
.
u
- c
.. '"
.. :;)
~ ~
..
~
>- ..
~ .
~t
..
..
.. c
. ..
...
., ii
~ 1
'" .!
w
CITY OF CAXPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell. CA 95008
(408) 866-2150
ttlCROACHMENT PERMIT
(tor workinq in the
public riqht-o~-way)
Iuued (.(I -.J r; ...-1/
perait expire. in 12 aos.
Parait No.
q . ./
/ -/&.,
~- \ <=to
X-Ref. file
Application Data
Application expire. in 6 .OS.
APPLICATION _ Application i. hereby aade for a ~lic Works Perait in aecordance with Caapbell
Municipal Code, Section 11.04. (Application expire. in 6 aonthe if perait not pulled)
liACOr- 6'37cr
( EI-<JJ.)
A.
Work address or tract I /3110 - /4.<.0 l-!AII.IVFT AvE'
Ut1l1ty tnneb l~t1on ~~ A.l!f
Nature ot work: ~'I MAIN n! /A1f7"11L&1rlo~Jr 4uO j'll/Ire kilL/"
Attach five (5) copies at a drawing .howing the location, extent and d1aenaions of the work
The drawing .hall .how the relation of the pro~ed work to exi.ting surf.ce and underqrouncS
iaprove..nu. When .pproved by the City EncJin..r, ..id dr.vinq beCoaea . part of till. perait.
B.
c.
D.
The Ceneral ConcUtions for .11 perait. .re listed on the reverse .ide. SpeCi.l PrOVi.ions for
this perait are listed below. Failure to abide by the.e conditions and provi.ions aay ~ult
in job .hut-dovn and/or forfeiture of F.ithful ..rfona&nce Bonds and cash deposits. (S_
Caneral conditions 1 .nd 2).
E. An application fee .u.t .eco.pany thi. .pplication. fti. La ncm-nfuncSabla.
._.r _Heant J)~;:: ~CEI 9fA1.1.-.. ...-, 279-7/11-7
Address /.22 / F j, ___ A __~ _ _'!:~ Q Cj'~/.2//
I /
Is this work beinq done by the property owner .t their own re.idence? -Je. ~no
Coaplete and attach worker.' Coapen.ation .nd Contractor Inforaation foraa.
The Applicant/peraittee herabY .9ree. by .ffixing their .iqnature to thi. perait to bold the city
of .
eaapbell. its officer., .venta .nd ..ployee. fne, ..fa .nd berale.. froll .ny cl.1a or deaan4 tor
daaaqes resultinq froa the work covered by thi. perait.
The Applicant/Peraittee hereby acltnOVledqc. that they beve read .nd understand both tha front and
back of ~ ~r1ait. a,M t~Y ~_in:o~/l:eir contractor(.) of the inforaation.
ACCEPTE?~ 0< ~ /7JV/Lt'.E Ic;'1(
Applicant (Peraittae) print/.ign Date
E"D-GV,I.IV C, /I.o')E'..LL-o/~,A.lC:?//l-te~F.vq .>v~~\.JtSO~
NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABlZ CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR truST HAVE THIS PERMIT AND APPROVED PLANS AND truST IIEE'l' WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO DAYS BEFORE STARTINC WOR)(.
NOTICE truST BE GIVEN TO PUBLIC WOIU(S AT LEAST 24 HOURS BEFORE RESTARTING ANY WOR)(.
SPECIAL PROVISIONS
_1.
Street shall not be open cut for underqround installations. Mini.WI cuta aay be .llowed
for connections or exploration boles. Such cuts ~ust be .oecificallY aDDroved by the
Insoector.
Pavement aay be cut for underqround installationa .nd .u.t be re.tored in .ccordance with
the Utility Trench Restoration Standard Dravinq.
Work to be staked by a licen.ed Land Surveyor or Civil Enqinaer .nd two (2) copie. of the
cut aheets sent to the Public Work o<<ptartaent before .tartinq work.
The hours at work are li.ited to outside the hours of 7-9 ..... ~..,p'1!- t~ eYUOrk
a tect1ng a traffic lane. '- ~ ~ 5
~.u~
i, .. . <'i.~ ~-;. ~ 0= Per<- JLltJ ~), 0 \991
. L.~ I2.-E?ce.L:)i~V--(;E-~~ \..Ul~ .
8-~\2.<2::\U\('- ~L0 ~~c-..;> Pub'icWorlultn(unee''''~
/
_2.
~.
_4.
~
CR-ll
STANDARD
AMOUNT
S \<:c>. tJC)
s ..--..
RECEYPT NO.
9
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
BONO FOR FAITHFUL PERFORKAMCE
($50.00)
$100.00
$500.00
(100\ OF ENC. EST.)
(4' OF BOND, $500 KIN)
S
$
$ \COre~ 9
k>-~~-q \
oate
CASH DEPOSIT
($200.00)
PLAN CHECK , INSPECTION
F~~~'I
tor City c:;e
APPROVED FOR ISSUANCE
t: PWPERMIT
Revised 7/90
'"'
I
I
I
I
I
I
I
I
I
I
I
I
I
I
0-3
o
tl:l
trJ
()
o
~
t"'
trJ
0-3
trJ
o
tl:l
><
~
'd
t"'
H
n
>'
z
0-3
I
I
I
I
I
I
I
I
1
I
I
1
I
I
I
H
c5
ttl
[I:;
()
o
~
t"'
trJ
0-3
trJ
o
ttl
><
()
H
0-3
><
I
I
I
I
I
I
I
I
1
I
I
I
I
I