96-203
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERMIT
(for working within the
public right-of-way) ~
blued {j,"'f:qfe,~
Permit expires in 2 mo
Permit No. 96-203
X-Ref. file
~liutionDa~ 7/15/96
~lication expires in 6 months
APPIJCATION. Applicalion is bereby IIIIde for I Public Worb Pamil ill ICCOI..... willi CaqlbeII MUJIil:ipII Code, Secdoa 11.04. (AppIicMioa expires ill 61111abs
if lbe permit is DOt issued. Applic:adoD Fee is __rdmdIble.)
A.Warkaddrcu orlnc:tl 457 McG1incey (x-st. Griffith)
Utilily II'eIICb location
B. NIIUre of worlt
EMERGENCY Main Repair - 4'x4' cut in concrete
C. Auadl four (4) copies of ID euaiDeCnd plans IbowiDa lbe ICICIIioIIIIIlI CllleIl ollbe wort, IIIlI four (4) copies ollbe pnIiaIDry JiaciDecr', Eadmare of wort. The
pIIIIs abIIl abow die reIMion of lbe propoaecI worIt to aistin& IUJface IIIlIlIIIIIerpouud iqmmaIaD. WbaI appnmd by lbe Cily EaP-. aU! pIIII bII:Ilaa . pin of
dIis permit.
D. All worlt aba1I confarm to !be City af CaqJbdI StaIIdard SpecificIDoaa IIIlI DcIaiIa for Public Worb CoaauucIioa; lbe GeDenI Pamil CondiOOat Iiafed CIIIlbe revene
,ide; IIId lbe Special Previsions for Ibis permit. Iiafed below. F~ to abide by lbeae lXlIIditioaa IIId proviaiIJIII may rauIt ill job _-down lIIlIIor forfeiIure of Failbful
Pa1C11'111111Ce Suretiea IIIlI cash dcposiu. (See GeucnI Pamit Coaditioaa II11l1 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. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
NlllleofApplicanl San Jose Water Company T~279-7979
-llll'illl )
AcIcIress 1221 S. Bascom F!Ve~ San Jose 9512~HOUR EMERGENCY TELEPHONE NO.
Is dIis worlc beiDa clone by !be property owner Illbeir OWD residence?
Yes
No
The ApplicantlPermiaee hereby apes by aff'axina lbeir lipaIure to Ibis pcrmilto bold lbe Cily of CaqlbeII. iIa officen, ..... IIIlI ~ free, safe IIIlI barmIcu from
any claim or demand far daJnaces resulq from lbe worlt covered by Ibis permit.
The ApplicanllPmniaec bmby lICknowledges lhIl tbey bave nldllld lIIIdemand bodIlbe t'roIIllllll bIck of dIis permk. IIIlIIbey wW iDform lbeir COImCtDr(I) of lbe
information.
Accepccd
Jane Leinberger (EMERGENCY VERBAL)
(AppliclDllPamiaec) (lip)
7/15/96
DIIe