96-194
CITY OF CAMPBELL ENCROACHMENT P~ 'lit No. Cjb - / 94-
DEPT. OF PUBLIC WORKS (for working within the 'i) .eo. Jf. File
70 North First St. public right-of-way) ~ \" 1ia
Campbea, CA 95008 tpf$ hlJ C. ~ ~ ~6/ c;
(408) 866-2150 Issued 'I'" ,/1? at.. ~pplication Date 1 ~ I 1 ~
Fax (408) 376-0958 Permit expires in 12 mos. () 15 ~pplication expires in 6 mos.
'\'''\ ~ c S
APPLICATION - Application is hereby made for a Public Works Permit in accor~ce w!!p~~~~uniciPal Code, Section 11.04. (Application
expires in 6 months if the permit is not issued Application Fee is non-refundable). ..,\S1Rrs.
."vN\\I'
A. Work address or tract # ~f'; c i. ~, ~
Utility trench l~tion 1// . _.:; ~ ~ ./ A(d... @, d .9 C) ~ .Lt~/'r ~ '" ~---r--~
BN,rureof_k ~L,., t" L( . -\- .-?' ~h " -,.,::- -f~~ ~~J~::~;:'~;
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 Works 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 General Permit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HA VB TillS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORK.
Name of Applicant/Permittee J;"L"Y)../ ':J~L./
Address
Is this work bein
The Applicant/Permittee 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.
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