96-202
CITY OF C!cl\~' ;~ELL
DEPT, OF PUBLIC WORKS
70 North First St.
Campbell. CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMF\"T PElU,~IT
(for working within the
public right-of-way)
Perm;,1'\o 96-202
X-Ref. file
Issued
Permit expires in 12 m
Application Date 7 /12/9 6
Application expires in 6 mos,
APPUCA nON - Application is hereby IIIIIdc for a Public Works Pamit in ICCOI'dIIII:e wilb Caqlbe1I MWIicipaI Code. Secticm 11.(14. (Applic:atioD expires in 6 months
if lbe permit is DOt issued. Application Fee is IIOII-refundable.)
A. Work addras or IrII:t ,
270 Dunster - 92' n/o Latimer
Utility traICb Ioc:ation
B. NIIUre of wort
EMERGENCY Water service repair
C. AUadI four (4) copies of III enaineered plans sbowina lbe loc8Iion lIIId CltID of lbe wort. lIIId four (4) caples of lbe prdiminary Eqineer's EatimIle of wort. The
plans shan show the relation of the propoacd wort to cmq aurflCe lIIId IIIIlIeIJrouud iqll'OVCIIICIIII. When Ipproved by lbe City Eqineer. said plan bec:omea a part of
Ibis permit.
D. All wort shall conform to the City of Campbel1 StlIIIdard SpecifICllicms lIIId DeIaiIa for Public Worb ComlnlClion; lbe Geacra1 Pamit CcmdiDona listed on the rcvcne
side; lIIId the Special Provisions for this permit. listed below. Failure to abide by these c:ondiIioaa lIIId provisions may result in job ahut-down lIIIdJor forfeiture of Faithful
Paformance Sureties and cash deposits. (See Geacra1 Pamit Conditioaa 1 and 2.)
E. THE CONTRACTOR MUST HA VB TIDS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOnCE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant San Jose Water Company
A~s 1221 South Bascom Ave., San Jose, CA
95128
II this work beilli done by the property owner at their own residence? Yes No
Tdcphone 279-7979
24 HOUR EMERGENCY
TELEPHONE NO.
The ApplicantlPermiuee hereby qrccs by aff1xina their sipature to this permit to hold the City of CaqIbeIl. ill oft1cas. ... lIIId cmp10yeca free. safe and harmless from
lilY c:laim or cIcmand for damaces resultin& from the wort covered by this permit.
The Applil:antlPcrmitte hereby acknow1edles that they have read 8Dd 1IDIIcnlalld both the froDt 8Dd hack of this permit. 8Dd they wID inform their COIItl8CtOr(s) of the
information.
Acc:cpted
Jan Kibbe (EMERGENCY VERBAL)
(ApplicantlPermiltec) print/sian
7/12/96
Date
CITY OF CAMPBELL
S"0vJC '
D~ltu-
CONTRACTOR: !?;0L r;~vL I
PROJECT NO. 1b ~ J. ~ 2-
REPORT NO: ,
DATE: ~ 7- s/-90
FIELD ENGINEER' S DAILY REPORT
WEATHER: 6;/
INSPECTOR: K. ~51fALL
ITEM
DESCRI:PTION
cc:
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