96-205
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)
Permit No. 9 6 - 2 0 5
X-Ref. file
Application Date 7 /16 /9 6
Application expires in 6 months
APPUCATlON . AppliaUm is heRby IIIlIde lor. Public worts Pamit ill accoc__ wiIb CaqIbdl t.IwIici!* Code, SocIion 11.04. (Applicaiaa apinll ill 611111111bs
If die permit is DOt issued. Applicltion Fee is __relimdlble.)
A. wort addras or na ,
1250 Midwav (x-st Patio Court)
Wily traICh localion
B. NaIure of wort
EMERGENCY Main Repair - 3'x4' cut in concrete
C. AIlIcb four (4) copies of aD qiDecred plans IbowiDa die Ioc:aIII and aaea (1/ die WOIt, and four (4) copies of die pnIimiaary ........ IIIIimIIe (1/ wort. Tbe
plans abIll abow the reIalion of Ibe proposed wort to cUsIiD& aurfII:e and lIIIderpouDd ~aDaIII. Wbea approved by Ibe City Eupa:r, IIid pIao becamea . pan of
lbia permit.
D. All wort .ball conform to the City of CaqIbd1 Standard Specifadoaa and DcWIa lor Public Worts Coaauuaioa; die GeamI PIrmil C"""itWw Iiated ClIIdIe rmne
.ide; and the Special Provisions for Ibis permit. listed below. FIiIure to abide by dIC:Ie COIIdirioaI and provisioaa may reauh ill job abu&4IwD and/or forfeiIurc of Failhful
PafGnIIIIX:C Sureties and casb deposits. (See Geoeral Permit r~itioaa 1 and 2.)
E. THE CONTRACTOR MUST HAVE TlDS 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 T~ 279-7979
(PriDllllUlle)
Acldress 1221 S. Bascom Ave., San Jose 95128z.4HOUR EME1lGENCY TELEPHONE NO.
b lbia wort beiDa done by the property owner at their own raidence?
Yes
No
Tbe ApplicantlPmnillec hereby aarees by aff"1Xina Ibeir .ipaIurc to lbia permit to bold die City of CaqIbd1, ill ofIicen, IpIIII and eqJloyeca free, safe and bIrmIeu from
any daim or demand for cIamaaes raulq from Ibe wort covered by lbia permit.
Tbe Applicamll'ennilllle hereby lICICDowJedps lbIllbcy have reId and IIIIlIcmaod bodI the from and bIdt of lbia penIIk, and Ibey will inform Ibeir ~.) of die
information.
Accepted
Jane Leinberger (EMERGENCY VERBAL)
(ApplicalllPtrmiaec) (.ip)
7/16/96
Dale