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96-229 CITY OF CAMPBEL~ IJ e;, 'C. ENCROACHMENT PERMIT DEPT. OF PUB1I<\ WQRKS (for working within the 70 Nurth F~ SIt. public right-of-way) ~~tI5~'95()()Z ~\ \~~~ Issued 9 J J 0 )c.lP Application Date 9/10 J:i (p Fax (408) 3~8 . . <" I"'l',. Permit expires in 12 mos. Application expires in 6' mos~ .' p."\' APPLICATIOt-{.,:,1R~~8Jn is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. expires in 6 mo~ the permit is not issued Application Fee is non-refundable). 7\[; t~IL3fP--\ 4-' X4' tAr HOL:: rmit No. ,.-Ref. File CJ{-; - 22 q (Application A. Work address or tract # Utility trench location I,.) wA 1 Dl ~ I J, H0\J L..D .. f") <-J'- - B. Nature of work I ,rJ S. f P- I 6- fJ. ; -5E.QVIl...E.~ C. Attach four (4) copies of engineered plans showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer, said plans become a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) Name of Applicant/Permittee E. THE CONTRACTOR MUST HAVE TillS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WO~. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. AeJIY\ \11 \~ ~,-(.. ~rv 101.3 P 6 [ f I --fer m J-- 11 ntr.nt-- ~t<- Telephone 12.. 1) - L 0 0 ) I () 0 00 ;J _ 1J L A rJ f ~{ ,~\; [ _ /l (- ( U I' L /!. r / :J v ~)50/4- Address Is this work being done by the property owner at their own residence? Yes )C No The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant/Permittee hereby acknowledges that they have read and un contractor(s) of the info~ion: .J-rcLJE FH (Applicant/Permittee) rstand both the front and back of this permit, and they will inform their t~ L) - 1- -j G C l T'I - , <! ~ ) ~.o \' '-..:r APPROVED FOR CONSTRUCTION. City of C~ampbe!h/ /'7Q Public Works Perrr\it No. /b-?-L I .'3 ~ Contractor mUst hiJlfe 1'1Iese pions on the job sit!! c!urlng cr,,,str,,r:tion, or: LAMPI3E.LL PEQMI\ j K frLH CuJIOMER AD.iJl,J6 DtJ_ Putt.. (0 It-lS[R.T 65.' DF 3/4" ST(EL WtTI-\ l/V' PLASTiC J ((.l.IrV {2.EMAI"'I,J(~ 2..' of '/t'l PLA ~T' c. A fJD :l/4-11 N.C. R.ISEJ1.... ItJ (U!:.TONl(n... D\Ju lP-td.H AfV~ DO ALL Of.-F SITE. l,JOfZk._ ,.7f' y~\ PL(J/4-) \>t/ ~ - - - - """"'---T- :x:: ~ 51'-+- I :N -0 ~ I ...J I- "" ~ cl ll.J c!) -.J U- HAZEL o Ln \'-- ~ -('.I A\/E._ t: J 5 T D M [(2 Ie> -r r:.. f N C. H o./-' .5 ) T [ A ,- IH E R I .5 E fL l (> tAT (:;).; ) rL[('....LlUIE.. l-iOu.ULltJE A/"D Hf.lV[' 1""- r,v:)r tcr U 5'1 TI1 E c 1''1 DF' L.J\MPBELL.