96-169
:ITY OF CA'..:PoELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCR().~,CHME!\'l PERMIT
(for working within the
public right-of-way)
Issued S'. J ~ ) q ~
Permit expires in 12
F:;rT~:1 Ku.
X-Ref. file
96-169
Application Date 5/13 /96
Application expires in 6 mos.
APPLICATION - Application is hereby IIIIde for. Publk worts Pamit in 1CCOIdluu; willi CaqIbdl MIIDicipal Code, SectioIIl1.04. (ApplicltioD expires in 6 molllhs
if the permit is DOt issued. Application Fee is DOD-reNudab1c.)
A. Wortaddrcu orlrlCtl 670 Budd Avenue @ Sobrato
Utility lraIch loc:ation
B. NClrc of wort
3 X $ cut in asphalt - emerqency main repair
C. AlUICh four (4) copies of an enaineercd plans showina the locaion IIIlI eIlaIl of the wort. IIIlI four (4) copies of the prcIimiJIIry Eaciaeer's EItimIte of wort. The
plans shall show the relation of the proposed wort to existina surface IIIlIlIJICIapouud ~1'OYCIIIaIIS. Wben approved by the City Eaciaeer, said plan becomes a part of
this permit.
D. All wort sball conform to the City of Campbell Standard SpecifalioDs IIIlI DcWls for Publk Worts Coastruc:cion; the Gcaenl Pamit Coadilicms 1is1ed 011 the reverse
side; and the Special Provisions for this permit, listed below. Failure to abide by tbesc CODditions IIIlI provisions may rauIt in job sbw-clown and/or forfeiture of Failhful
Paformancc Surctic:s and casb deposits. (See Gcaenl Pennit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HAVE TlDS 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 (Jane - emerqency)
Telephone
24 HOUR EMERGENCY
TELEPHONE NO.
Address
1221 S. Bascom Ave., San Jose 95128
Is Ibis work bciD& done by Ibe property owner II their own residence?
Ycs
X
No
The ApplicamlPcrmiuee hereby qrees by atrlXina their siparurc to this permit to bold Ibc City of CaqlbcJl, ill officers, IICIIIS IIIlI cqJloyees free, life and barm1css from
any c1aim or demand for damaacs resultina from the wort c:ovcred by Ibis permit.
The Applic:antlPennitte bereby acknow1edlCS IbIl they have read and undcntand boIb Ibc front and bacIc of this permit, IIIlI they will inform their COIIUKlDr(S) of the
infonna1ion.
Accepted
SAN JOSE WATER COMPANY (Jane - emergency verbal)
(ApplicantlPcrmiuee) prinllsip
5/13/96
Dale
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