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CITY or CAIIPBZLL
DZP'f. or PUBLIC 1fORD
70 North Firat st.
CUIpbell. c:A 9500.
(40') .....2150
9'1-(h~
~CROA~ PmIMT'!'
(fer work1nq in the
public riqbt-of-vay)
I.8Ued In' 1 <) - C( I
Pena1t upiz'u i.D 12 _.
Penit Re.
X-Ref. fil.
Application Dat. 6/ 14/ g 1
Application upirM in 6 110..
APPLIc:A'l'%OH - Application 18 bereby _de for a Public Worb Peztlit in accordance with C&IIpbell
Municipal COde, Section 11.04. (Application upirae in 6 IIOfttba if penit not pulled)
A. Work addrae. or tract t
3751 S. Bascom
II.
Otllity 1:zwncb location
..tun of work: Install util Hies as 'per attached sketch 5DE00947
Attach five (!I) copi_ of a clrawinq abowinq the location, extent and cU..eneiona of the work
The clrawinq aball abow the relation of the propoalld work to ex1atinq aurface and Imderqround
t.praveaenta. When .pproved by the City Engineer, aaid drawing becoae. . part of th1a per1Iit.
The General COnditiona for all penLita are listed on the revene side. Spacial Prov18ione for
this pea1t an li.ted belovo 'ailure to abide by th... conditions and Proviaions uy re.ult
in job abut-down and/or forfeiture of Faithful Performance Bonds and caab depoaita. (8_
General. COnc:li tiona 1 and 2).
Z. All application f_ _t accoapany this application. Th18 18 non-rerundable.
Hue of Applicant Pacifi c Gas & E1 ectri c 'l'alepbone: 408/725-2229
A4d~~ 10900 N. Blaney Ave., Cupertino
c.
D.
I. this work beinq done by the property owner at their own ~iam:e7 --y- JS..no
co.plet. and attach Morken' Caapens.tion and COntractor Inforution foras.
The Applicant/PermJ.t~ bereby agre_ by affixing their 819ftature to tbis"penLit to bold the City
of
campbell, its offican. agenta and -.ployee. free, safe and barale.. t~ any cl.ta or d..and for
daaag_ ~ultin9 troll the work caveZ'ed by thi. penlite
. ,
The Applicant/lie be
bacK of thi.
Ac:c:zJITZD
Date
ey have read and undentand both the front and
ntractor(.) ot the information.
6/14/91
NO'l'ZS: ALL WORK SHALL COMPO" 1fI'1'B 'l'BE A'l"l'AamD. APPROVZD PLUs AlII) ALL APPLICABLE CUlPULL
STANDARD DRAWINGS ~ COHD1'1'XDlfS. R E eEl V E
'l'BE COlft'RAC1'OR Wft DVZ 'fUS PDIII't AND APPJh.IVBD PloUI8 AND IIUS'1' lID'!' WI'l'Ii 'l'BE P.W. IJfSPEC'rOR ~
'1'D SI'l'Z H LUST '1'110 rays 8D'OD STAR'.rDIG IIOU. J UN 1 :-' 1991
NOTICE JlUST BZ GIVD '1'0 PUBLIC WORD H LUI'1' 24 IIOOR.I auoa D8TAR'l'I1IG AllY 1IOB.
Public Worb/fngineering
SP!:CYAL PROVl:S:rOHS
..J::::::1.
Street .ball not be open cat for unc:lerCJroUDd install.tions. lI1niaua cuta uy be allowed
tor ccmnectiona or exploration bol_. Such cuta mue1: be eaecificallv almroved bv 1:he
In.~.~tIr.
pav_t uy be cat for underqrounc:l installationa and .ust be ~tored 111 acc:ordance with
the utility 'l'rench Raatoration StancI4ri Drawin9.
Mc!:'k to b: E~ boo; Co lic:g:::=! ~~ sm:"1f!yer or c'.v:!.! ~,~~ ~!! ~ (!) ~i'!'!! e~ t:!o!!'
cut ab_ta .ant to the Public: Work Doptartaent befl:lre startinCJ work.
'!'b. boura of work an li.1Ud to cutaide the boun of 7-9 .... UIll 3-. p... for any work
affectinq a traffic lane.
_2.
_3.
V'"'4.
~
~ C-=>..f C~__~)~ ~~---l _ ~~ if.....)
~e.~~~ i(L) t.,-{;.J- ~L..:T~CC-:::".
"-"':..u~ OA ~f)~ ~~U\\~4~~~
'.-1 ,
!I'I'1NDARD
AMmrH'P H~YPr HD.
$ \~.<!C) 9
$ -
.
$ --:---.
. \CO.6CJ ~
b-~'~ \
'.. \,., ~te
, ' \"'.
PZJUII'1' APPLICATION l'D (Uo.OO)
PLAIf CllZCJt DUOSI':
BOND FOR FAI'l'BFOL PD!'OlUIUCE
CA.SB DZPOSn' "200.00)
PLAIf CllZCJt , IJfSPEC'l'ION l'D
$100,000 - $500,000 9',
APPROVED FOR ISSUANCE
$100.00
$!l00.00
(loot OF ERG. 1ST.)
(4' OF BDHD, '500 KIM)
- $100.000 10"
" , $100 KIM)
.t,..
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neer .. ")
(SEE cmD!:l'5m:\.i
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