96-195
CITY OF CAMPBELL
PUBLIC WORKS DEPT.
70 N. First St.
Campbell, CA 95008
(408)866-2150
FAX (408)376-0958
OWNER OCCUPIED R-I
NO FEE ENCROACHMENT PERMIT
(for working within the
public right-of-way)
($5,000 maximum value of wor~
ISSUED 7/25)qoJar(i;i
I
Permit No. 910 - /95
X-Ref. File i5:5 ~
Application Date <0' ,I
RECEIVED
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell M3tftfe ~tion
11.04. (Application expires in 6 months if the permit is not issued.) c.I ~
~ . 1.. ~J l-lUui...IC WUi{ti.."
A. Work Address IO~ S::,!1'J.. .j UA-Mfpelt ll.n~I~'5TR^TIQ"'~1
B. Nature of Work Pi_if.. _~...) "'T~
C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing sbal1 show
the relation of the proposed work to existing improvements. When approved by the City Euginecr. said drawing becomes
a part of this permit.
D. All work shall conform to the City ofCampbeU 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 ,bide by these ~:)nditicns:md p:"...isicn3 may .~su:t mjot shut-JuWil .nilk,. fvrfc;iiUie ofFaithiui Performance Sureties
and cash deposits. (See General Permit Conditions 1 and 2.)
NAME OF APPLICANT &n-tt ~~ TELEPHONE 4c:Y-<(JJ'- 5'S-77
(Print Name)
!U>DRESS~07~ ~ i11. ~ ,l( ~ ~ B
Complete and attach Workers' Compensation and Contractor Information forms.
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.
ereby acknowledges that they have read and understand both the front and back of this permit, and that
on tor(s) e' ormation.
ACCEPTED
NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE
CAMPBELL STANDARD DETAILS AND CONDmONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST ARRANGE TO MEET WITH
THE PUBLIC WORKS INSPECTOR AT THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK. ff~b-:lIt:. 5'
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
PER SECTION 4215 OF THE GOVERNMENT CODE THIS PERMIT IS NOT VALID FOR EXCAVATIONS UNTIL
UNDERGROUND SERVICE ALERT (USA) HAS BEEN NOTIFIED AND THE INQUIRY IDENTIFICATION NUMBER
(TICKET NO.) HAS BEEN ENTERED HEREON. USA PHONE: 1-800-227-2600. TICKET NO.
AM?
$N14
RECEIPT NO.
r City Engineer
Months After the Date of Issuance
"1 :.25: 9/:1
Date
APPROVED FOR ISSUANCE
( SEE OTHER SIDE)
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CITY OF CAMPBELL
Public Works Department
July 9, 1996
Scott Mackenstock
1075 Smith Avenue
Campbell, CA 95008
Re: Tree Planting
Dear Mr. Mackenstock:
In response to your request regarding replacing the' street tree that the City recently removed,
the City has reviewed the trees in your area and detennined that the variety of tree to be planted
shall be a Chinese Pistache tree.
Please be reminded that an R-l Encroachment Pennit must be completed by you and issued by
the City prior to any work being done. There is no fee for this permit; however, depending
upon the scope of the work, a refundable surety deposit may be required.
When returning the Encroachment Permit, please submit a simple scale drawing of the area
between the curb and sidewalk, and indicate where you desire to plant. Once the pennit has
been issued, please contact me to arrange for inspection of the work.
If you have any questions, please call me at 866-2165.
l?J:i!ia!!
Public Works Inspector
70 North First Street' Campbell, California 95008,1423 ' TEL 408,866,2150 ' FAX 408,379,2572 ' TOO 408,866,2790
NEW PW FAX #
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CITY OF CAMPBELL
Public Works Department
June 19, 1996
Scott Mackenstock
1075 Smith Avenue
Campbell, Ca 95008
Re: Tree Planting
Dear Mr. Mackenstock:
Thank you for your recent telephone inquiry regarding replacing the street tree that the City
recently removed. Enclosed is an application for an R-l Encroachment Permit which must be
completed by you and issued by the City's Public Works Department prior to commencing work.
There is no fee for this permit.
Also enclosed are the City's approved Tree List and planting requirements. The City requires
that you plant a tree from the list which is consistent with the trees already planted on your
street. We will review the trees in your area within two weeks and provide suggestions as to
acceptable varieties.
When returning the Encroachment Permit application, please include a simple scaled drawing
depicting the general area and the relationship of your proposed improvements to existing streets,
sidewalk, driveways, utilities. adjacent trees, and other facilities located in the immediate area.
It is very important to establish that the placement of the new plantings will not interfere or
damage existing improvements. Once the Permit has been issued, please contact me to arrange
for inspection of the work, and to approve the tree before it is planted.
If you have any questions, please call me at 866-2165.
E. rely. -L L~ ~
-~7 ~(
Randy estfall
Public Works Inspector
Enclosures
cc: Vince Huppe, Park Maintenance Supervisor
70 North First Street' Campbell, California 95008,1423 ' TEL 408,866,2150 ' FAX 408,379,2572 ' TOD 408,866,2790
NEW PW FAX #
40R_~'7"_ooe;:n