96-237
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 1- ~3' %
Permit expires in 12 moDtbyjt*,r-
/ II
Permit No. 96-237
X-Ref. file
Application Date 9/20/96
Application expires in 6 months
APPUCATlON . Application is bercby IIIIde for. Public Worb Permit ill *XiOCdancc willi Campbell M~ Code, Secdoa 11.04. (Applica&iaa capUa ill 61111111bs
If die permit is not issued. Applic:alion Fee is __refuDdable.)
A. Wort addnss or 1I'ICl' 961 Emory (x- street S unn yoak s )
Utilily lraICh Ioc:alion
B. NaIUrC of work
3" X 4" cut in dirt for emergency main repair
C. Aaach four (4) c:opics of an cnaincered plans sbowiJIa die IocaIioa IIIlI Cll1IIIl fIldle wort, IIIlI four (4) c:opia fIldle preIiIIIu.y EDIiDeer'I lIadDIIIe fIl work. Tbe
plana aba1I abow die rcIIIion of die propoaed wort to aiaq aurfal:e IIIlIlIIIdeqrouDd iIIIproveaIaIIa. WbaI appnmd by die City EDIiDeer, aaid plan '--- . JIIl1 of
dIia permit.
D. AU work IhalJ conform to die City of Campbell Slandard Specificadoaa IIIlI D&IaIla for Public Worb CoaatrucUoa; die Geaeral Permil ('_;,w. liated 011 die rm:ne
lide; and die Special Provisions for this permit. listed below. Failure to abide by theae CODditioaa IIIlI proYiaioal may nauIt ill jab ....4IwD raJlor forfeilIare of Faithful
PufOl1lllllCC Sureties and cash deposits. (See Gencral Pamit rnnclitinnt 1 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. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant SAN JOSE WATER CO. (Jane -emergency verbal) T~
(print name)
Acldras 1221 S. Bascom San Jose 95128 24HOUll EMERGENCY TELEPHONE NO.
11 dIia work beina done by the property owner It their own raiclence?
Yes
X
No
Tbe ApplicanllPennillee bereby aarees by afflXiD& their lipaIure to this permit to bold the City of Campbell, ill officen, aaaa and employees fnc, IIIfe and barmIesa from
any claim or cIemand for damaaes raulq from die work c:overed by dIia permit.
Tbe Applic:anllPennillee bereby ackDowlqes lhat they have read and UDdcnland both the frod and bII:t of this permit, IIIlI they will inform their CXIIII'ICUlI'(I) of the
information.
Aa:eplcd
(Applil:antlPermill) (lip)
Dale