96-181
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96-181
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell. CA 95008
(408) 866-2150
Fax (408) 376-0958
(for working within the
public rigbt~f-wa )
Issued b5 1
Permit expires in 12 mo .
X-Ref. tile
Application Date 6/3/96
Application expires in 6 mos.
APPUCATION . Applic:alion is bcreby .-de for a Public Worts Pamit in -=rdUIl:e willi CaIIIpbeII MlIIIicipaI Code. SecIioD 1UN. (App1il:lDoa aplra in 6111D111bs
If die permit is not issued. App1ic:alion Fee is DOD-refundable.)
A. Wort address or II'lICt ,
1136 Steinway {x-st Peggy}
UliIity aax:b 10000000n
B. NaIUre of wort
EMERGENCY Main Repair - 3'x4' Cut in Asphalt
C. Aaach four (~) copies of an qineered plans abowq die Ioc:aDoa and aIeIIl of die wort. and four (~) copies of die ~ EaaiMer'. iIIimIIe of wort. The
plans Iha11 .bow !be reIItion of die propoICCI wort to aistiDa IIIIfIce and 1IIIlIeqrouDd improwmeall. Wbeo approved by die City EaP-, uid plio becomeIa pmt of
dais permit.
D. All wort shall confonn to !be City of CampbeI1 SCandIrd Specificalioas and DccaiIs for Public Worts Coasuuaion; die GearnI Pamit CAPclkioIIIliIled onlbe reverse
.ide; and the Special Provisions for this permit. Iisled below. Failure to Ibide by lbese ClIIIdilioas and provilious may rauIt in job sbut4rn lIIJdIar forfeilure of FIithfuI
PIlI'fOl1llllllCe Sureties and cash deposits. (See GearnI Pamit CoIIcIilious 1 and 2.)
Name of Applicant
San Jose Water Company
(prinlllllDe)
1221 S. Bascom Ave, San Jose, CA 95128
Address
TELEPHONE NO.
24 I<<>UR I!MEJUlEloO'
279-7979
Is this work beiDa done by the property owner . lheir own residence?
Yes
No
The ApplicantlPenniaee hereby agrees by atrWna lheir sipalure to thiI permit to boJcl die City of CaIIIpbeII, ill officers, IpIIIS and eqlloyees free, aafe and barmIess from
any claim or demand for dlmages resultina from lbe wort covered by dais permit.
The ApplicantlPenniuee bcreby 1CknowJed&es that lbey have read and UDdentand bocb lbe front and bII:t of dais permit. and lbey will inform lbeir COIIlnClOr(s) of lbe
iDfOl'lDlllion.
Aa:eptcd
Jane Leinberger {EMERGENCY VERBAL}
(Applic:aDtlPermiaee) (sian)
6/3/96
Dae