96-244
CITY OF cAMAEI- C t: II V ~ ~
DEPT. OF PUBLic woRks'" ~ ~",;
70 North First St. 0
Campbell. CA 95008 OT () J 1996
(408) 866-2150
Fax (408) 376-0958 PtL;~;':' \',' ..,-
ADMIN/STRA no~.
APPliCATION _ Applicalion i, hereby ..... "". Public W_ Pennit ;n ."",,"""'" with Campbell Municipal C""'. Section 11.04,
expires in 6 months if the permit is not issued Application Fee is non-refundable).
-'lCROACHMENT PERMIT
- ---~
,r working within the '
public right-of-way) 1C ' \
_;) ~)r. ' Crt I '
/0 I 'l({ >},J/ A._
Issued ,YO---,. " !L /
Permit expires in 12 mos. I -~
Penn it No.
X-I File
16 ~Lfl
'tb.../ ~ I
.
~
Application Date It; - / -- f k
Application expires in 6 mos.
(Application
A. Work address or traCt # --rRAC. gJ? ~ -f /2..30 "IAl!.elc-r Ave
Utility """'" Jocatioa' C f2.o < 'A/: I!,~ r A' 2.1' - 0 ,a,,1JA WAr z. R f". LOt-ATE: LLf~L r"'-'- &OX:
J) 41)( 3' SELL HOLC to C-",r- orr' bA5 5C~ vf c.L
B. Natu<e of..... / '-L c"As-l-e:J-crllu- f';4{.-fL' n"'-=- ~ 051/&03470
-rl<. A- c.... ...,-
C. A_ fou< (4) oopi'" of """"""" ptan. ,mowing tho ,_on """ "t<>tt of tho won. """ fou< (4) oop'" of !he prelUnirwY F.og;n="
&;timalt of worl<. Tho pi"'" """ ""ow !he """on of!he propo"" won to ,,u,ting """'" """ w>de<groond ;mprov"""'''' WhoO "",rov<d by
the City Engineer. said plans becOme a part of this permit.
D. All worl< _ 000_ to tho City of Compbell _d Sp<cifi<atiom """ ])otai" fo, Public W_~; !he """'" Pennit Conditiom
I""'" on !he <<V<= ""'; """ tho Sp<ciaI _i""'" fo< ..,. ponnit, H=' below, F,;lore to "';de by tb= oooditiom """ provi'- may """, ;n
job ...-dowO aod!o< _ture of Fabhful Ped_ """"" """ """ ~i", (See """'" Pennit Condi- I aod 2.)
E. TIlE CONTRACfOR MUSf HA VB TIllS pERMIT AND APPROVED PLANS AT TIlE SITE AND MUSf NOTIFY THE PUBliC WORKS
DEPARTMENT AT LEASf TWO DAYS BEFORE SfARTING WORK. NOTICE MUSf BE GIVEN TO PUBliC WORKS AT LEASf 24 HOURS
BEFORE RESTARTING ANY WORK.
Name of Applicant/Permittee
Pacific Gas & Electric Company
Telephone (408) 725-2022
AI (;11>1... 7;), r;~~oll ,.., 17~-j905
,
No
Address 10900 North Blaney Avenue. cupert;~o. CA 95014
Is this work being done by the property owner at their own residence? Yes
Tho ApplicaollP"""'" _ """'" by affi>tiog _ 'i"""",,, to"" ponnit to bold !he City of Cao>pbel1. i" offi<=, ..- """ omploy= free.
safe and harmless from any claim or demand for damages resulting from the work covered by this permit.
Tho API'lictollPemri"'" lioreby adoowiod<<, "'" they bave read """ oo<temaod bod> tho !root """ boC. of ..,. ponnit, aod they will iofonn thoit
contraetor(s) of the information:
/Ja;f&.. Vy ~ /o-;-9G
(Applicant/Permittee) print/sign Date