96-267
CITY Oi CAMPBELL 'NCROACHMENT PERMIT
DEPT. ('IF PUBUC WORKS _,or working within the
70 North First St. public right-of-way)
~j~~~2~~o95008 Issued II. I g. 9"[
Fax (408) 376-0958 Permit expires in 12 mos.-17'r 1/ '-I '7
APPUCATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. J\PPli1m ~
expires in 6 months if the permit is not issued Application Fee is non-refundable).
Pr
X-h~'. File
No.9/:; ~ 7
<2.,;
A. Work address or tract # IF 0 / q 7 C.URT AI &e A -IE.
Utility trench location NDL11I cF c..J,Ull)~ A~ f.) f!c:.~';t.r:..L E.~t:... ~ ~t ~
~.) 4' #-rU::IN L.E c:.- b. S. '1c..E.
B. Nature of work R e PI...A U;;; e x I , r / J6 -j, L. J <-c. 13 0 x {:jN ...5r bc::wALlL A€eA . 0 . 054 If 04- ;z..
A ^-in ..sa:. VI u::. ., / N 5 f5(!.;rJON
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 General Permit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HA VB TIllS PERMIT AND APPROVED PLANS AT TIIE SITE .\ND MUST NOTIFY TIffi 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 ApplicantlPenmttee
Pacific Gas & ~~ectric Company
Telephone (408) 725-2022
Address 10900 North 81 aney Avenue. Cuperti no, CA 9501;"
Is this work being done by the property owner at their own residence? Yes No
The ApplicantlPermittee 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. ' "
',- 1
The ApplicanrJPermittee hereby acknowledges that they have read and understand both the front and back of this permit, and they' will 'fu~eir
contractor(s) of the information:
Ru~~ (!.HIU. ('$~cz:2..
(ApplicantlPermittee) print/sign
/fl'i/'ir.
Date
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