96-230
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) ~
Issued qf I jt; t&{~ 0 ')
Permit expires in 12 .Donms-.
Permit No. 96-230
X-Rd. file
Application Date 9/11/96
Application expires in 6 months
APPUCA nON. Application is bercby IIIIde for I Public worts Pamit in Il:COIdIIIce willi CaqIbeU M~ Code, Sectiaa 11.1M. (AppI;".,w" apirel in 6 IIIIIIIIbs
It'lbe permit is DOt issued. AppIic8licm Fee is __rdiUIdIble.)
A. wort II1dras or InI:t ,
Uti1iIy Ireol:h Ioc:ation 628 Hawthorne Avenue, cross street page
B.NlllUreofwort water main repair, 2 X 2 cut in asphalt
C. AIIXh four (4) copies of an qiDeered plans Ibowia& lbe Icx:aIiaa and exmm ~ lbe wort, and four (4) copiel ~ lbe preliminary BaIiDeer'I BadmaIc ~ work. Tbe
plana aba1Ilbow lhe reIIDon of lbe pl'OpOlCld wort to Gistiua aurfacc and lIIIderpuuDd ~__. WbalIIppI'CMld by lbe City~, .... plan IIel:uaa I pIIt of
dIia permit.
D. All wort aba1I conform to lhe City of Campbell Slandard Specificmoos and o.ib for Public Worb CoaIuuc:lion; lbe GeDenI Pwmil C~iriont Iiated OD lbe _
licIc: and lhe Special ProvisiollS for this permit, Iiated below. FIi1ure to Ibide by lbeac CXlIIlIiIioaa and proviaioaa may rauIt in job abut-cIown fI1IJJIor forfeilure of Failhful
Paformance Sureties and ClSb dqxJsils. (See GeoenI Permit CoadiIioas 1 and 2.)
E. THE CONTRACTOR MUST HAVE nus PERMIT AND APPROVED PLANS AT THE SITE AND MUST N011FY 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 Applic:ant SAN JOSE WATER COMPANY (Jane-emergency verbal) T~ 279-7802
Address 1221 S. Bascom Ave<t~e~~an Jose 24 HOUR EMERGENCY TELEPHONE NO.
b dIia wort beina done by Ihe propeny owner II their own reaidm::e?
Yes
X
No
The ApplicanllPenniaee hereby aarees by alfWna their lipIlure to dIia permit to bold lbe City of Campbell, ill ofticen, .... and eqtloyes free, life and IIarmIeu from
any c1aim or demand for cJamaaes resulq from lbe wort covered by dIia permit.
Tbe ApplicadlPcrmiltee hereby lICkuowled&es that lbey have r.s and lttIdentand both lbe from and bIct of dIia permit. and lbey wID inform lbeir ~aaoi(') of lbe
information.
Aa:cpted
SAN JOSE WATER COMPANY (JANE - EMERGENCY VERBAL)
(ApplicamlPamiaee) (lip)
9/11/96
0IIc