96-191
CITY OF CAMPBELL ENCROACHMENT PEttrE eEl \; :IftNo. Cfb'- /q I
DEPT. OF PUBLIC WORKS (for working within the ~R~File ,Ie -/'-12 f 15 -.Ltc; '-f
70 North First St. public right-of-way)
Campbell. CA 95008 & (1 JUN 141996 J
(408) 866-2150 Issued U 1l.C Application Date t:,-II 1cp
Fax (408) 376-0958 Permit expi es in ~ UBLlC WU{{KsApplication expires in 6 mos.
ADMINISTRATION
APPLICATION - Application is hereby made for a Public Worlcs Pe in accordance with Campbell Municipal Code. Section 11.04. (Application
expires in 6 months if the permit is not issued Application Fee is non- fundable).
A. Work address or tract # ~1.3& ( Nzil755 )
Utility trench location WHI J1E.. MKS W ~ NfiTCI-I t;/t... C--{'. 76 ht,1!,~
B. Natureofwork ~;;111l..1!.f bto_~r;"/.4b i~ r/c,f",a _<:J:;J?1/lr~ nJ -n2;tt':..-F .fz3R
C. Attach four (4) copies of engineered plans showing the location and extent of the work, and four (4) copies of the preliminary Engineer's
Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by
the City Engineer, said plans become a part of this permit.
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Worlcs Construction; the General Permit Conditions
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in
job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See GenerUermit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HAVE TIllS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS
DEPARTMENT AT LEASf TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WO~.
Name of ApplicantlPermittee Mal L Al:j'jh...h~ / &/~/L.- ~.I~' Telephone 443-1;gg
Address ?41513 Ai 1>}S'-r lit'}; 7..00 ~~./ rJ, '56 ('r fQ7;<!
Is this work being done by the property owner at their own residence? Yes' ~ No
The ApplicantlPermittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free,
safe and harmless from any claim or demand for damages resulting from the work covered by this permit.
The ApplicantlPermittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the information: -?
b,/J 0/0
Date
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