96-175
CITY OF CA~;FBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell. CA 95008
(408) 866-2150
Fax (408) 376-0958
Per::!:! No.
X-Ref. file
96-175
Issued
Permit expires in 12 mos.
h
Application Date 5/20/96
Application expires in 6 mos.
APPUCATlON - Applic:ltion is bm:by IIIIdc for a Pllblic Works Pamit in Il:cOtdancc widJ CaqJbcII MUDicipal Code, Sa:cioa 11.04. (App1k:ation expires in 6 moDlbs
if lbe permit is IIIlt issued. Application Fee is ~refundable.)
A. Wort address or llICt ,
Burrows Road 240' south of Hacienda
Ulility treDCb location
B. Nllure of work
emergency main repair
2' X 2' and 2' X 5' holes in asphalt
C. AIlIdt four (4) copies of an eDlinem:d plans sbowina lbe loc:aIion and atem of lbe wort, and four (4) copies of lbe preliminary ED,ineer's EstimaIe of work. The
plans shan show the relalion of the proposed work 10 elistina IUrfIcc and IIJllIapouDd improvemeall. Whallpproved by lbe City EDaiD=, uid plan ba:omc:I a part of
this permit.
D. All work shall conform 10 the City of C~belI Slandard SpccifJCalions and Dc:lai1s for Public Works Consttuc:lion; lbe Genenl Pamit CoadiDons lilled on lbe reverse
side; and Ibe Special Provisions for this permit, listed below. Failure 10 Ibide by lbese c:oadilioas and provisions may RIIIlt in job lbut-down and/or forfeilure of Faithful
PmClnlllllCe Sureties and cuh deposits. (See GenerII Pamit Conditions 1 and 2.)
E. THE CONTRACTOR. MUST HAVE nus PER.M1T 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.
T~ 725-2176
24 HOUR EMERGENCY
TELEPHONE NO.
PACIFIC GAS & ELECTRIC
N' 8{CUUL1 /;}v( /k.<-L C;;;:J.U. /"z/1i) I/) 95:JIY
../ '
Is this work being done by the property owner at their own residence?
Name of Applicant
Address /0900
Yes
X
No
The ApplicantlPmniaee bm:by qrees by aff"ixina their siaJlature 10 this permit 10 bold lbe City of~, ill offlCCll, IpIIS and employees free, safe and barmleu from
any claim or demand for daml&es resultina from lbe work covered by this permit.
The Applic:antlPennitte hereby IICknowledaes that they have read and UDderstand both lbe front IIId bICk of this pc:rmit. IIId they will inform their COIIInCIOI'(s) of the
information.
Accepted
PACIFIC GAS & ELECTRIC (Gwen)
(ApplicallllPermiltee) prinllsip
5/20/96
Date