96-196
Permit No.
X-Ref. tile
96-196
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERl',ET
(for working within the
public right-of-way)
Application Date 6/2 8/9 6
Application expires in 6 mos.
APPLJCAnON . Application is bereby IIIIdc for. Public worts Plmil in aa:anIaIIcc wkh Campbell MuIIic:ipal Code, SectioD l1.CM. (App1il:adoD aplra In 6111011lbs
if cbe permit is DOt issued. Applicalion Fee is IIOII-refuudable.)
A. Worhddreu orlrlctl west side of Third Street - 23 I n/o Campbell Avenue
Utilky lreIId1loc1Uon
B. NIIUre of wort
EMERGENCY Main Repair - 2'x2' cut in asphalt
C. AaadI four (4) copies of an qineered plans sbowia& die IocaIioa and araa or die wort, and four (4) copia of die pntiminary EuaiDeer'a IlIIiIaaIc of wart. The
plaas IhaIJ show tbe relation of die pI'OpOIed worIt to exiItiua surf8cc and 1IIIlIaJround illlptO\l~. WbeIlIppl'OVOd by die Cily ED,iDeer, aaId plaD bIcamra . pan of
Ihia permit.
D. All work shall conform to lhe City of CampbeIJ Scandard SpecificIIioas and DelaiIs for Public Worb COIIIInIClioD; die General Pamit (".....irioaIliated OIIlhe nvaae
aide; and the Special Provisions for this permit. lisled below. Failure to _ide by Ibese CODdiIioaa and provisiolll may result in job abut-cloWD rdJar forfeiIure of Faithful
PwfonllllllCe Sureties and cash deposits. (See GeaeraI Pamit Coadilioos 1 and 2.)
E. THE CONTRACTOR MUST HAVE TIDS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
~ TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUCWORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
San Jose Water Company
(print 1IIDIe)
1221 South Bascom Avenue, San Jose, CA ~~NENO. 279-7979
Namr: of Applicant
T~
24 II>UR BMI!RGIH:Y
Address
11 this work beiDa done by lhe property owner at their own residence?
Yes
No
The ApplicantlPmnittee hereby agrees by aff'Wna Ibeit sipalure to Ihia permit to bold die City of Campbell. ill officers, .,eau and ~1oyeeI free, ufe and barmIas from
any c:Iaim or denWId for damages rcsuItina from the work c:ovemI by this permit.
The ApplicantlPermittee hereby acknowled&es that they have rail and WIdentand both die froot and back of Ihia permit. and they will iafarm IbeIr OOIIIIXtoI'(s) of die
iDformation.
Accepted
Jane Leinberqer (EMERGENCY VERBAL)
(Applil:antlJ'ermilr) (sip)
6/28/96
Date