96-262
S- '0 \...
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APPLICATION - Application is hereby made for a Public Works Permi(llii~~Mahee with Campbell Municipal Code, Section 11.04.
expires in 6 months if the permit is not issued Application Fee is non-refundable).
CITY OF r AMPBELL
DEt'T. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-Q958
\
ENCROACHMENJ;.,PJ;.BMJI
(for working withiJ~e~ r.:" !Ii' 11 "t Ir,;
public right-of-way)
Issued j oj R- L e,l r~ '; 1 4'1991
Permit expires' 12 mos.
nit No.
~-Ref. File
9b~J&J. ~
Application Date /6//tf/9?
Application expires iD. 6 mos.
(Application
A. Work address or tract # 500 q In MA R /J VE / SIJU 7 J-.I OF J..J ~ MI L T/) Y A v/:-- - i I1P If PI/ ;;;l'1kl/7:s
Utility trench locationW I T 1-1 C--/ri 11 () A D w J OfF),I/VC' . .
B. NatureofworkMOVC SFfiV/h.E Btlx TO BClt1lkf} 51/JFW/it.Kj RL:t.IJ(;,ATf;" C IJ!/J){NT,
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 GeneraW>ermit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HA VB TInS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORK.
Name of ApplicantlPermittee P A f'... I F I c... r1 ELL
Address 31 ?) B, Iv I I) I 5 /, 5 JJ)./ J tJ 5 L~ elL
Is this work being done by the property owner at their own residence?
qS-/ J1
Yes X
Telephon~ P r)4'1 1'.- 72 36
77 M::tJ:. I' rJ 0
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 u1ting from the work covered by this permit.
CITY OF CAMPBELL
FIELD ENGINEER' S DAILY REPORT
PROJECT NO. 9b - U 2-
REPORT NO:
CONTRACTOR: I/"ft CG"..t!:r,
DATE: Ju /~ 1/
WEATHER: PAIR.
INSPECTOR: K. .v~51'fALL
ITEM
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