96-176
CITY Oi C'A.Mrr.:LL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
EN~ROACHMEl\'T FEPJ\1IT
(for working within the
public right-of-way)
15/23/ q(,
Issued
Permit expires in 12 mos.
P~'"mjt No.
X-Ref. file
96-176
Application Date 5/22/9 6
Application expires in 6 mos.
APPUCA nON - Application is bereby IIIIde for . Public Works Permit in accordm::e wiIh Campbell Municipal Code, Section 11.04. (Applieation apires in 6 IIIOIIIbs
if Ibe permit is Illll issued. Application Fee is lIO~rdilndable.)
A. Wortaddras orlnlCtl East side of Louise Ct., in front of 625 Louise Ct.,
300 ft. nlo Hazelwood
Ulility treDCb location
B. NllUre of work
EMERGENCY repair of gas leak
C. Aaach four (4) copies of an enaineercd plans showina Ibe IOCIlion IIIlI eltenl of !be wort, IIIlI four (4) copies aC!be preliminary &,ineer's EatimIIe of work. The
plans sball show the re1alion of the proposed work to elliscin& IlIlfal:e IIIlIIIIIlIerpouDd improvemeDll. Wbal approved by cbe City &,ineer, uid plan becomes . part of
1hiI permit.
D. All work sball conform to the City of Campbell Standard SpeeifJC:8licma IIIlI DecaiIa for Public Works CoIIatruclion; cbe GeaeraI Permit CcmdWoIIa Iialed on Ibe reverse
side; IIIlIIbe Special Provisions for this permit. listed below. Failure to Ibide by tbese coadiIiona IIIlI provisions may resuh in job abut~ lIIlIIor forfeiture of Faithful
PerfOl'llWll:C Sureties and cash deposits. (See General Permit CODdi&ions 1 and 2.)
E. THE CONTRACTOR MUST HA VB THIS PERMlT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOnCE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Address
PG&E
10900 N. Blaney Ave, Cupertino 95014
Telephone 725-2033
24 HOUR EMERGENCY
TELEPHONE NO.
Name of Applicant
11 Ibis work beill& done by Ibe propeny owner It lbeir own residence?
Yes
No
The Applicant/Permittee bereby agrees by aft'IXina lbeir sipature to this permit to bold Ibe City aC Campbell, ill oft"K:erS, IpDtIIIIlI employees free, life IIIlI barmlesa from
any claim or demand for dama&es resultin& from the work covered by 1hiI permit.
The ApplicantlPermittee bereby ac:knowledaes tbIt Ibey have read IIIlI uodentand bolb !be froa IIIlI back of 1hiI permit, IIIlI they wW inform their ClOIIInCtOr(s) of cbe
information.
Acc:epted
Sandra (EMERGENCY VERBAL)
(ApplicantlPennittee) priDtlsiln
5/22/96
DIte