96-159
CITY OF CA_\1PBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENG'OACHMEJ\il PERMIT
(for working within the
public right-of-way) ~
Issued /t!22)Qtp ~ .'
Permit expires in 12 mos. -
Pr~m!t !\il_'
X-Ref. file
96-159
Application Date 4/2 2/9 6
Application expires in 6 mos.
APPLICATION. Applic:alion is hereby IIIIde for I Public Worts Permit in ICCOI'dIDce willi CaIIIpbeII MWIicipaI Code, Section 11.04. (Applicltion expires in 6 IIIOIIIhs
if \be permit is DO( issued. Applicalion Fee is non-refuDdable.)
A. Work Iddras or trlICt ,
Campbell Avenue & Third
Utility lI'aIcb location
B. NllUre of work
EMERGENCY PERMIT - Locate buried splice
C. Attach four (4) copies of III engineered plans sbowina \be Iocaion IIId cuaJl of \be wort. l1li1 four (4) copies of \be prdiminary EDaincer's EstimIre of work. The
plans shall show the relation of the proposed work to exiJtin& JUrface IIId IIIIlIaJround improvemallS. WbcD Ipprovcd by \be City EucDa', uid plan becomes a pan of
Ibis permit.
D. All work shall conform to the City of Campbell Standard SpeciflCllicms aad Detai1s for Public Works C_auc:tion; \be General Permit Conditions Iiaed on \be n:vcne
side; and the Special Provisions for Ibis permit. listed below. Failure to Ibide by lbese ~ l1li1 provisions may rauk in job sbut-down lIIdIor forfeintrc of Faithful
hrfOl1lWlCe Sureties and cash deposits. (See General Permit Conditions II11d 2.)
E. THE CONTRACTOR MUST HAVE nus 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
Pacific Bell
Telephone
24 HOUR EMERGENCY
TELEPHONE NO.
493-7133
3475B North First Street, Rm 200
~an Jose, CA ~~~j4
Is this work being done by the property owner II their own raidence? Yes No
Address
The ApplicantlPermiuce hereby qrces by aftlxina their siJnature to Ibis permit to bold the City of CatqlbeII, ill oftk:cn. IpIIlIIIII1 employees free. safe and hannless from
lilY claim or demand for damaaes raultina from the work covered by Ibis permit.
The ApplicantlPermiuce hereby acknowlcd&es tbat \bey have read and undcnland both the fun and back of this permit, aad \bey will inform their contral:lor(s) of the
information.
Accepted
Shirley Webb (EMERGENCY VERBAL)
4/22/96
(ApplicantlPermiuce) print/sian
DIle