96-272
CITY OF CAMPBELL ENCROACHMENT PERMIT r it No. q(o ,212-
DEPT. OF PUBUC wORKS (for working within th~ :x. ___f. File
70 North First St. public right-of-way)
Campbell, CA 95008 I
(408) 866-2150 Issued Application Date \ \/2..0/qro
Fax (408) 376-0958 Pennit expire:; in 2 mos. " 2 .Application expires in'6 mos.
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APPUCATION - Application is hereby made for a Public Works Pennit in accordance with CampbetI'l<ftinicipal 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 # !E.A~'" ~lt>a 01= 8E/l..Te.bl::N D~. ~ROM :iI\/aiO 6EI\~'Det,j ~O'OTH"10 \70Lt..A.RD RD.. At...~O t>.lC\Z.TtI
Utility trench location SIte OF PD\..1.. p,J2D R[). ~Ii:.DM e,EA.~DE:)J \ 00' EA~T.
B. Nature of work ~eE.NCI-l BAc..K.t=Il,L. ~ IN'S-rALl.. 12KV PR\M~"" It-J Wl\.IClIJ1"f.S.D. # ()~Ie:C)\~Z.l
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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 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-<iown and/or forfeiture of Faithful Perfonnance Sureties and cash deposits. (See General Pennit Conditions I and 2.)
E. THE CONTRACTOR MUST HAVE TIllS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WO~. NOTICE MUST BE GIVEN}O PUBUC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORKa;dn' a ~/.>~h-<-r(.Jje,u./ L Uc / ~~ / -f!;Jj;;(};-2 d/ .;
Name of Applicant/Permittee Pacific Gas & Electric Company Telephone (408) 725~
Address 10900 North 81 aney Avenue. ClJperti 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.
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