96-201
CITY OF '~AMFB:;LL
DEPT. OF PUBLIC WORKS
70 North First 8t.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHME\: PERM7T
(for working within the ~ \
public right-of-way) ( cr7Jr1:Jj
Issued 7 /J 2-/ 1 ~ ~
Permit expires in 12 mos.
Per!:;;: )\.,' 96 - 201
X-Ref. file
Application Date 7/11/9 6
Application expires in 6 mos.
APPUCA T10N - Application is hereby IIIIde for a Public WOIts Permit in accordaDce willi CampbdI MIIDicipaI Code, SectioIll1.04. (Applicalion expires in 6 moDlbs
if Ibe permit is DOt issued. Applicalion Fee is _refundable.)
A. wort address or tract ,
1009 San Tomas Aquino Road (x-st Westmont)
Utility treIICb Iocalion
B. NIIIIre of won
EMERGENCY Main Repair - two 2'x2' cuts in asphalt
C. AaadI four (4) copies of III qineered plans ahowiD& the location IIId ataIl of Ibe wort, IIId four (4) copies of Ibe preIlminary ED,ineer's EItim8 of won. The
plans sballshow the relation of the proposed worlc 10 aiatina aurfac:c IIId \IIIdcrarOuDd iqlrovcmcaa. WIlen Ipproved by Ibe City Eaaineer, laid plan IIecloDa a part of
dIia permit.
D. All worlc sball confonn to the City of CampbeJI SlIDdInI SpecificaIions IIId DcWIa for Public WOIts Coaattuction; Ibe 0eaeraI Permit r.....iricq listed on the reverse
side; and the Special Provisions for dIia permit. listed bdow. Failure to abide by Ibeae CODditiona and provisioaa may rauIt in job abut-clown and/or forfeiture of Faithful
Perfonnancc Sureties and cash deposits. (See 0eaeraI Permit Conditioaa II11d 2.)
E. THE CONTRACTOR MUST HAVE nus PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant
San Jose Water Company
1221 Bascom Ave., San Jose, CA 95128
Telephone 279-7979
24 HOUR EMERGENCY
TELEPHONE NO.
Address
11 this work being done by the property owner at their own residence?
Yes
No
The ApplicantlPcrmiuee hereby agrees by afflXina their sipature 10 this permit to bold Ibe City of CampbdI, ila oft'lCCn, IpIItIIIId cqIloyeea free, safe and barmIcn from
lilY claim or demand for damages resultin& from Ibe worlc covered by this permit.
The ApplicantlPcrmiuee hereby ICIcnowledles that they have read IIId UDdentand boch Ibe frcmt IIId bIck of dIia permit. IIId thcy wID inform tbcir COIIIraCtor(s) of the
information.
Accepted
Jane Leinberqer (EMERGENCY VERBAL)
(ApplicantlPmnit1ee) print/sian
7/11/96
Date