96-158
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACmv!E~i PERMIT
(for working within the
public right-of-way) GiiiJ
Issued 4\1 q lq(p 1U
Permit expires in 12 mos.
Permit K
X-Ref. file
~"l~~
Application Date 4 /19 /96
Application expires in 6 mos.
APPLICATION. Application is berdly made for . Public Worts Permit ill aa:ordaIIce willi CaqIbeU MUJIicipaI Code. Section 11.04. (Applicalion expires in 6 molllhs
If tbc permit is DOt issued. Application Fee is IIOIl-refuDdable.)
A. Work Iddress or tnICt ,
Bascom Avenue, 75' north of Campbell Avenue
Utility tteDd1Iocalion
B. NllUre of work
3' X 3' cut in asphalt for main repair
C. Attach four (4) c:opies of III qineered plans showina tbc IocaIiou IIId exIaIl of tbc wort, IIId four (4) c:opies of tbc preliminary EuaiDeer's EstimIIe of worlc. The
plans sball sbow the re1ation of the proposed worlc 10 eUstin& surf_ IIId UIIdap'OuDd improvemeull. When Ipprovcd by tbc City EDaiD=, IIid plan becomes a pan of
Ibis permit.
D. All worlc sball CODfonn 10 the City of ~I Standard Specif'atioas IIId DelaiIs for Public Works CoaslrUCtion; tbc GeIIeraI Permit Coaditiom Iistcd on tbc reverse
.ide; IIId the Special Provisions for Ibis permit. listed below. Failure 10 lIbide by tbcse CODdiIionIIIId prvvisiona may result ill job sbut-dowD lIIdIor forfeilure of Failbful
PerfOl'llWlCe Sureties IIId casb deposits. (See GeIIeraI Permit COIIlIiUons Illld 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant
SAN JOSE WATER COMPANY
Address
1221 S. Bascom Avenue, San Jose
95128
Telephone 279-7847
24 HOUR EMERGENCY
TELEPHONE NO.
Is this work being done by the property owner at their own residence?
Yes
x
No
The ApplirantlPenniaee hereby I&I'CCS by atrlXina their .ipllUre 10 Ibis permit 10 bold tbc City of CaqlbeII, ill offic:en, IpIIIS IIId ~1oyea free, safe IIId barmIess from
lilY claim or demand for damaces resuJtina from tbc work covered by Ibis permit.
The Applil:antlPenniaee bereby lICIcnow1edaes tbat they have read IIId UDdentllld both tbc front IIId bacIt of Ibis permit, IIId they will iDform their CXIIIInCIOr(S) of tbc
iDfonnation.
Accepted
San Jose Water Co., Jane, emergency verbal
(ApplicllJtlPenniaee) prillllsian
4/19/96
Date