96-207
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 ript-of-way)
Issued r[-/HIo ~
Permit expires in 12 IDO .
Permit No. 96-207
X-Ref. tile
Application Date 7/18/96
Application expires in 6 months
APPUCA nON - Applicalion is hereby IIIIde for . PlIbIic worts PIrmit in accorcIaDcc willi CaIIIpbdl MuDicIpaI Code, Secdoa 11.04. (AppIiraIiaa apUa in 6 IIIlIUbs
If the permit islllJt issued. Applicalion Fee is ~Ie.)
A. wort addreu or lrICt ,
580 Hamilton Avenue at San Tomas Expressway
Utility IrCIICh kaIion
B. NIlureofwork fire hydrant repair, 4 I X 5' cut in concrete
C. AIIICh four (.) c:opies of ID qineered pllDl sbowiDa the IocIUaa aDd ca.- vi die wort, aDd four (.) c:opilll vi die pnIiIDiMry JiDcinecr'I EatiIDe vi wort. Tbe
pIanIlballlhow the reIaIion of die propoaed wort 10 cxistiIIa IlII'fac:e aDd lIIIIIerpauDd iqll'OYClllalll. Wbco appnmd by die City JiDcinecr, laid pIaD bec:oaIa . pin of
lbiI permit.
D. AD work lbaII confonn 10 lbc City of CmIpbdJ SIIDdard SpecificIUoas aDd DelaiII for P\lblic Worts CoaIIrucIioa; die 0caaaI Pamil Ctonditiftno IialDd 011 tbc reverse
lide; aDd lbc Special Provisiona for this permit, lilted below. FIiIure 10 abide by lbeIe ClIlIdiDoIlIaDd proviIiODI may rauIt ID jab ....-down rII/IJI,. forfeiIure of Faithful
PafOl'llllllCC SurcUes aDd casb deposits. (See GcoenI Pamil Coaditioas 1 aDd 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMlT 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.
T~ 279-7900
Name of Applicant SAN JOSE WATER COMPANY
1221 S. Bascom Av~~~h Jose
Address
24 HOUR EMERGENCY TELEPHONE NO.
b this work bcin& done by the property owner at their own reaidencc?
Yes X
No
Tbe ApplicantlPenniaee hereby IIree5 by aff'1XiDa their I~ 10 this permit 10 bold tbc City of CaIIIpbdl. ill offian, lIeDIIaDd llIIIployees free, life aDd barmIcu from
any claim or demand for cIlIInaces reaultiD& from die work eovered by this permit.
Tbe Applic:anLlPenniuee hereby ac;tnowledps thIt they bave nIId aDd UIIlIcnwJd both die from aDd bIcIl: of this pamil, aDd they wW inform their CIOIIInI:lOr(I) of lbc
information.
Acc:eplCd
SAN JOSE WATER COMPANY (Jane - emerqency verbal)
(ApplicaatlPermiuce) (lip)
7/18/96
DIIe
CITY OF CAMPBELL
FIELD ENGINEER' S DAILY REPORT
ITEM
) J Ve .
56'0 W
CONTRACTOR:
DESCRIPTION
cc:
REPORT NO:
PROJECT NO. 9~ -ole)
DATE: 7..-'1C;-9~
WEATHER: PAIR.
INSPECTOR: K. ~G:-51fALL
CO/lC. J! Jrj tJ./(J~
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IT
PAGE: I
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