96-278
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERMIT
working within the
..ublic right-of-way)
Issued 12/ I 2)~ lp
Permit expires in 12 mos.
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Application Date V - J', - ,/ cp
Application expires in 6 mos.
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 # GAL C- V rz
Utility trench location 0/ '? I P6 Gl\L.E: t'j:Z
,
B. Nature of work I H t;>TAL L: S4o'- ~ I'
( V?u IA~. t7~. fJO. E:. 7- 0"2 S )
I=' ru b1 MAIZA TH tJ tJ .t'f2.. ~ ~ l'
t?/CL rifE vvATe.t2- MAlt-.!
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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. p.r.heqAP~roved by
the CIty Engineer, said plans become a part of tins permit. . )~.'j6
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 HAVE THIS 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.
Address
Is this work being done by the property owner at their own reSidence?
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Name of Applicant/Permittee
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Yes
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 hannless from any claim or demand for damages resultmg 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 mform their
contractor(s) of the information: ~? ,/ / '
H,t:e~, ~ lZi'qj'lb
(Applicant/Pe ittee) print/sign Date
(see other Side)
crry OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
PROJECT NO.
REPORT NO:
CfC;
q G,. '2.. 7 25
DATE: 3 -- () 5- ?17
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WEATHER:
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CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
PROJECT NO.
qc.- 2 -70
REPORT NO:
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DATE :
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FROM WEST VALLEY CONSTRUCT! ON 408 371 3604 (MaN) 03. 03' 97 09: 22/ST. 09: 21/NO. 3562 \ 53958 P 3
.JAY AREA GEOTECHNICAL GROUP
950 INDUSTRIAL AVE.. PALO ALTO, CA 94303
(415) 852.9133
17^~~
CONTRACTOR EOUIPMENT IN USE
DAILY REPORT PAGE NO. I
,*ST v/Jlk';f {l1lJ1.fT7&J076&; DATE P.~/19 7
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REMARKS /?7AHU.F L ~~/V'.at!'Z t!}/V <.5/"/i.. /17n-~/77.
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CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
PROJECT NO.
Q"'Z.78
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REPORT NO:
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DATE :
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WEATHER:
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CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
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PROJECT NO. (1 {-~2 7
REPORT NO:
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Ie 1<; IJL N<:i\V' I fv'-l{ DATE:
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WEATHER:
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CONTRACTOR: WFi...~ T VAUfl..Y Go...;.:-;:
INSPECTOR:
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