96-214
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) 0
_ 811::'1'l&"~
Permit expires in 12 !DO
Permit No.
X-Ref. file
96-214
Application Date 8 / 7 / 9 6
Application expires ,in 6 months
APPUCATlON - Applicltion is bercby IIIIde for. Public Worb Permit in ICCOCcIMc., willi CIqIbdI M~ CocIc, Secdoa 11.04. (ApplirwMa lip_ in 611111111bs
If Ibe permit is DOl issued. Applicllion Fee is ~Ie.)
A. wort IIIdreu or IIlICl ,
456 Budd Avenue (x-st Emery)
Utility lreIICb location
B. NIIUre of worlt
EMERGENCY Main Repair - 3'x4' cut in asphalt
C. AIIICb fClUr (4) capies of an qincerrld plans aIIowina Ibe IclCIIioa and CIal of Ibe wort, and fClUr (4) cap.. of Ibe pn:lImiDIIy EapIecr'I EstlD*C of wort. Tbe
pi-. sbaII sbow the reIabon of Ibe propoIed wort to aisliDa ~ and IIIIdIqraund iqIrovcmaa. Wbca IppnMld by die City Jlacioecr, Slid plan beI:ameI . part of
lhis permit.
D. All wort sbaIIlX)nform to lbc City of CampbeU Slandard Specif\cIDoIII and DelaIIs far Public Worb CoaIauaioo; die 0aIen1 Permil r_itlnno lilted CIII die reverse
lide; and !be Special Provisions for Ibis permit, listed below. Failure to Ibide by dICIc COIIdiUoIII and proviIioaI may I'CIUIl in job ....4JiwD fI/IIJIor forfc:iIuR of Failhful
PIrlormance Sureties and cash deposits. (See Gcoenl Permit Coadiliollll and 2.)
E. THE CONTRACTOR MUST HAVE TInS 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 2A HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant San Jose Water Company T~ 279-7979
Address 1221 S. Bascom, ~r:nJ>ose, CA 95128 24HOUR EMEIlGENCY TELEPHONE NO.
b Ibis worlt beina done by Ibe property owner Illheir own residence?
Yes
No
Tbe ApplicantlPermiuee hereby aarees by aff'axina Iheir lipaIure to Ibis pamit to bold lbe City of CIqIbdI, ils otIii:c:n, IpIIII and ~1oyeeI free, safe and IIIrmIesI from
any c1aim or demand for ctamaaes resulq from !be wort covered by lhis permit.
Tbe ApplicantlPermiuee hereby acknowled&es IhIlIbey have read and IIDdenland bocb !be frca and bal:k of lhis permit, and Ibey will Inform 1beir COIml:lOI'(I) of Ibe
information.
Accepted
,T;::lnP T,pi nhprgpr (RMRRr,RN('Y Vprhrll )
[Applic:anllPermiaee) (liIO)
8/7/<)6
DIIe