96-164
CITY 0: CA.."'fr:SL:"'~.
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
E\'CIWACHME:\~ !'ERMrT
(for working within the
public rigbtoOf-way)
Issued- J 0-
Permit expires in 12 mos.
f~~:nit Ns. 9 fi -1 fi 4
X-Ref. file
APPLICATION. Application is hereby IIIIde for a Public WOJb Permit ill acconIaDce ~ ~J~l1.04. (Applic:ation expires in 6moDlhs
if'the permit is DOt issued. Application Fee is non.ref\mdable.) ~ I,]
A. Wortaddrcss orlrlCtl 101 W. Rincon (cro3s street Winchester)
Utility lmICb location
B. NllUre of work
EMERGENCY service kill
C. Auach four (4) copies of In enginemd plaDs sbowiDa the IocIlicm IIIlI euaJt of the wort, IIIlI four (4) copies of the preliminary EuaDer's Eaw.e of wort. The
pIaDs sball sbow !be relation of the proposed work to aistin& IIIIIfKe IIId IIIIderJround Improvemeall. Wben Ipproved by the City ~. said plln becomes a part of
Ibis permit.
D. All work shall conform to the City of Campbell SlIIIlIIrd Specific:Dms IIIlI DeWIs for Pllblic Works CoaslnlCtion; die General Permit Conditions IiIled on die reverse
side; and !be Special Provisions for this permit. listed below. Failure to Ibide by lhese c:onditioas IIIlI provisiollS may result in job shut-down aodIor forfeilure of Faithful
PmClfllllllCe Sureties and cash deposits. (See General Permit (,onditnlo 1 IDII 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.
NIIIIe of Applicant San Jose Water Company
A~s 1221 S. Bascom Ave, San Jose, CA 95128
Telephone 279-7979
24 HOUR EMERGENCY
TELEPHONE NO.
Is this work beilli done by the property owner III their own resiclencc?
Yes
No
The ApplicantlPermiuee hereby qrees by afflxiDa their sipllUre to this permit to bold !be City of CmIpbeII. iIs officen. I&enlS and cqI10yees free, safe and barmless from
IDy claim or demand for dama&es resultina from the work c:overed by this permit.
The ApplicantlPenniaee hereby IICtnowledles that tbey have reId IIIlI UDdenllDd both die from IIIlI bIct of :his permit, IIIlI tbey will inform lbeir CCIIItraClOr(s) of die
infoflllll.ion.
Ac:c:epted
Jane Leinberger (emergency verbal)
(Applicant/Permittee) prillllsiln
5/6/96
DIlle