96-269
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENTPERMUT
(for working within the
public right-of-way)
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h .,er. File
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Application Date
Application expires in 6 mos.
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APPLICATION - Application is hereby made for a Public Works Permit 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
3qL ~LDo ,fQl1,Q CAlf/geL L
ceos'.5/AJ6 f.,<..)ItL:/::)O fr"oAJJ /..3 l' JiGjo e-IO/?..'1 Azc
B. Nature of work /N.s.1ALL 64-.S AIUD EJ.Lcrt2.Jc rAc:../L r1i~ S.D. # 0.5'4'(,;,035,2..
JofNI ""f:e-6N<J-f ,)J/1?{ fJ;.If.:Nt:: A...xJ (,16Le: -ft)
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 improveme~. When approved by
the City Engineer, said plans become a part of this permit. ' ~ ~"'.
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D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the Genc:ral Permit 'COD~
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and p~y resuit iii' ~~,
job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) j '}g
, '96
E. TIlE CONTRACTOR MUST HAVE TIllS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY~ PUBLIC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAS!' 24 HOURS
BEFORE RESTARTING ANY WORK.
Name of Applicant/Permittee
Pacific Gas & Electric Company
Telephone (408) 725-2022
Address 10900 North Bl aney Avenue ~ Cuperti no, CA 95014'
Is this work being done by the property owner at their own residence? Yes 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 resulting from the work covered by this permit.
The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the information:
l10Av /}~ /I-I!?,9b
(Applicant/Permittee) print/sign
Date
v. (see other SI e - 7'C:
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Public Wo!';:::;) FJc:rrrllt
~)NSTRUCTION,
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C anf factor must hat'? these pions
0,., "he :'oh site cJur,:ng .:onstruction.
OR I V[lIRY
EX'Ii Z"HP STL
r[NCE
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WALDO ROAD
fOREMAN'S NOTE
INSTALL 84' Of 1/2-PLASTIC SERVICE
CO"PLETE WITH 3/4u N.C. RISER
PG&[ TO DO ALL THE TRENCHING
JOINT WITH [lECTRrC, PHONE AND CATV
CITY or CAMPBELL PERMIT
ADDITIONAL TRENCHING rOA TfL[PHONE
AND CABLE TV BY OTHERS TO TIE-IN
POINT Of CONNECTION
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V Iv #~9S609Le 90V
TYP. SERviCE JOINT TR[NCH
130"COV[R IN STREEt/DaIVEWAY AREA
If SOil Ii HOT aO(K fREE. HDU
4" TO OlPTH or TR[NCH rOR SRND
BEDDING
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'392
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392 WALDO RAOD
MOHAMMAD A. MOTIMEDOA
CAMPBELL, SANT A CLARA COUNTY
PACIFIC GAS AND ELECTRIr. r.OMPANY 0541603512
SAN FRANC I SeD, CAL IF ORN I A
~~lN3J JAS O~ll~3dnJ: LG:Ol ~ 96-91-11~
3~!ld: AH IN3S