96-258
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
7~rth First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
~NCROACHMENTPE~
.or working within the
public right-of-waYr
Issued 10 /!5/t1 ~
Pennit expires in 12 mos.
Pr No. q (0 - 2-5fS
X-L_.. File
Application Date I OJ ,1 J Cj l()
Application expires in 6 mos.
APPUCATION - Application is hereby made for a Public Works Pennit in accordance with Campbell Municipal Code, Section 11.04. (Application
expires in 6 months if the permit is not issued Application Fee is non-refundable).
A. Work address or tract #
Utility trench location
A-~ -+ ..,!Zc.AJc-H- ~f{..oIi 4LE:..
S.D. # O::;4/&JL32.. 19
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 confonn to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Pennit Conditions
listed on the reverse side; and the Special Provisions for this pennit, listed below. Failure to abide by these conditions and provisions may result in
job shut-down and/or forfeiture of Faithful Perfonnance Sureties and cash deposits. (See General Permit Conditions 1 and 2.)
E. TIIE CONTRACTOR MUST HAVE TIllS PERMIT AND APPROVED PLANS AT TIIE SITE AND MUST NOTIFY TIIE 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 ApplicantJPermittee
Pacific Gas & Electric Company
Telephone (408) 725-2022
Address 10900 North Blaney AvenlJP. Cupertino. CA
Is this work being done by the property owner at their own residence?
95014'
Yes
No
The ApplicantJP~rmittee 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.
/o-/D-9ra
Date
(16) SKETCH
.
~ 3
~ ~
--~.
~-
SKETCH
FOREMAN'S NOTE
INSTALL 138' OF I"PLASTIC SERVICE COMPLETE
~ITH 3/4"RISER AND 27' Of I"PLASTIC STUB
SERVICE FOR FUTURE LOT
PG&E TO TRENCH OrrSlTE: APPLICANT TO TRENCH
ONSITE AND EXCAVATE FOR ELECTRIC BOX
, t - ~ITY OF CAMPBELL PERMIT
.-__..... 11'
I
I
....
a c.Il
C:::
<.n
~
a
C:::
C:::
I
I
I a
l...J
1
;<
r16 -
i
!
" 1 '""
HAC 1 [NOA/4~?h
v
':' '1
'"",...
#1260
r,.-
'...,;-
"'~I
\,..",
.. ~
C~)
TYP.
STUB SERVICE
FUTURE
fLAG LOT
T
1:
o
a
l..J
>-
I
I
oJ
lJ)
\'J
'1" ~
',..J
()
o
'" r:
c: c
o .;::
"t.-~
~ ~
~ e
1".) e
:0 c:
D "::
..c: :!
~'"t'J
.~
Ct
.,........"
L..
,......
',' j
) -")
. .~
....',
,..;-..--",
c:
o
, ,
\"...,1
....."
C'
JDI~TR[NCH
130'COVER IN STREET/ORIVE~AY ARE
If SOIL IS NOT ROCK fREE. ADO
4" TO DEPTH Of TRENCH fOR SAND
BEDDING
CONSTRUCTION COORDINATING DETAIL
FIELD COOROINATOR'S NAME
TEL NO, ENGINEER'S NAME
725-2.{)3.J (17) !?OSIC.J)/L aAI-1~
117) 'B,LL LAK.e:...
TEL NO.
125 -2..041