96-227
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 riaht-of-way) , .;;;i9
Issued q/4 J9~
Permit expires in {2 months
Permit No.
X-Ref. tile
96-227
Application Date 9/4/9 6
Application expires in 6 months
B. NIIure of work
EMERGENCY Service Repair - 3'x41 cut in asphalt
C. AlIICb four (4) copies of III qiDeered pllDa IbowiDa die IocIIioa IDd CllIaIl of die wort, IDd four (4) cop.. of die pI'CiiaIDry &pIecr'1 ~ of wort. The
pIIDa IhalIIbow the rc1Ulo of die JlI'CIIIClHd work to CliItiaJ IIIlf'a:c IDd lIIIdeqrauad iDlprovaDlllD. WhaI approved by die City &pIecr, IIid pIID baxIlIIa . pin of
lbiI permit.
D. All work IhalI conform to the City of CampbdI SlIDdIrd SpecificIDoIIIIDd DecaiIa for Public Worb CoaIuuc:Iioa; die GcaeraI PInDit r---1iIled 011 die ~
lide; IDd die Special Provisions for IbiI permit, listed below. Failure to abide by tbeIe CODditioaIIDd proviIioIIIlIIIY nIIIIt Ia job IIIIIl-cIowD rlJlj/fIl forfcilure of Failbful
PafonJllllCe Sureties IDd cash deposits. (See GeaeraI Permk CoadilioalllDd 2.)
E. THE CONTRACTOR MUST HAVE THIS 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.
NameofAppIi<:ant San Jose Water Company T~ 279-7979
(priDllllllle)
Adclress--l22_l S. Bascom Ave., San Jose 95 l2ii HOUR EMERGENCY TELEPHONE NO.
15 IbiI wort beina clone by the propaty owner at their own raidence?
Ya
No
The ApplicanllPermiaee hereby aarees by aff'q their lipature to IbiI permit to bold die City of Campbd1, ill otficcn, IpIIIIIDd employees free, life IDd barmIcu from
Illy claim or denWld for damacc::s raulliDa from die work covered by IbiI permit.
The ApplicanLlPermittee hereby actDowlcdla dIlIl tbey bave read IDd UIlIIenland bolh die trod IDd bide of Ibis permit, IDd tbey will inform tbeir COIIIrII:fOI'(I) of die
Iaformation.
Aa:qlted
Jane Leinberger (EMERGENCY VERBAL)
(ApplicamlPermiuce) (lip)
9/4/96
Dale