96-280
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERMIT
(for working within the
public right~f.way)
=!;!~!~
Permit No, Q';;-?RO
X-Ref. tile
Application Date 12/20/96
Application expires in 6 months
APPUCA TlON - Applaion is berdly DIIIde for a Public Worb Pamit ill .x........ wiIh CaIIIpbdl MUDicipaI Code. Section 11.04. (Awl....... expira ill 6 IIIllIIlhs
if dle permit is DOl issued. Applicarion Fee is 1IlIIH'CtImdIb1e.)
A. Wort Iddreu or ll8Cl' 164 W. Rosemay at Eden
Utility lreIIl:h Iocalion
B. NaIure of wort
main repair, 2 X 2 cut in asphalt
C. AIrxb four (4) a1pics of an qiDecra1 plans showiD& lbe IoI::DJD aad aIID oIlbe wort. aad four (4) a1picl oIlbe pI'CiimDry &p.r'a EIIimIIc 0I.uk. The
pIIm shall allow lbe rda&ion of lbe proposed wort to aistiDa IlU'face aad lIIIIIapauDd illlpro..aDaIII. WbaI appnMld by dle cay &p.r, aid pIIa IIel:amaJ a.. of
dlia permit.
D. AD wort shall conform to lbe City of CImpbdl SIaodard Specifk:aioaa 11III DaaiIa for Public Worb CoaIauczioa; dle GcueraI Pamil r_loWot Iiaa1 lID lbe reYa'SC
aide; 11III lbc Special Provisiona for this permit. 1iat.ed below. F.wrc to Ibide by Ibae ClIIIIiiIiaaa aad provisiDnl may rauIt iD job IIIukIowD lIltIJ/or forfeilun: at FaidIfuJ
PaforJlllJlCC Sureties 11III cash dcposils. (See GcueraI Pamil C-itinas 111III 2.)
E. nm CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT nm SITE AND MUST NOTIFY nm 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.
San Jose Water Company (Jane - Emergency Verbal) T~279-7846
Name of Applicant ~
(pro. name)
Addrc::ss
1221 ~ Bascom AVe__ ~an Jose 95128
24 HOUR EMERGENCY TELEPHONE NO.
Is d1is wort bein& done by the property owner at their own n:sideDce?
Yes
X
No
The Applil:anu'Permiaee bereby acrees by 1ff1Xin& their ailz*ure to d1is permit to bold lbe cay of CaIIIpbdl. iIs otrx:en. aaaa 11III ~Ioyees me. life 11III bIrmIea &om
any claim or demand for dama&es n:suJtin& from lbe wort covered by d1is permit.
The ApplicarulPermiu.ee berdly adaIowledles thal they have rad aad IIDdemaud bodIlbe froat 11III bIl:t of d1is permit. aad they will iDform their ~~a) of lbe
information.
Aa:qlled
SAN JOSE WATER CO. (Jane - Emergency Vebal)
(ApplicallllPcrmiut) (ai&n)
12/20/96
DIlC
SPECIAL PROVISIONS ..:, _ >..,>_" :._ _ "'.:: _' _:' _, .::.::<>>:,:::. :':::.: ></:::- . - .'_ :_.: :,::: ':-><<-.::::::::>::::-:::' <::.:-':::::}>-:})_:<.:-:-.<:::::< >: :"/:>{':::::.::::::::{:':<_:::::{::":,:):=:<<:::}):::::.:<<:>::::::)::;>:)):::::::::'.:.:,:_:'.: _.
_1. Slr= shall nntbe open all ftlr~iIwnI!~.~iRi""""aJII!!!!Ibe~fi3&o~lln'''''l.la1or~IIiDJes;~~ma;1Ml~v
-'. .~5=~~~:::f~~~;~;m~'~~~~~~~~l~\~'
. _3. Woct to besraked by a licensed. I..IlId SurYeyor orOriEoplrler lIIId two CZ)copiaaf dle QI1I1leecs leU U)dIeNficWIlltl~ bcfolUilrlilllwoit..
_4. Pa- Scl:tion4215 of the GOYmIlIICIIlCode Ibis penDit illIlltY&lid for ~ umil Uaderpou:ndServil:e~~)blablaA1rificdllllfrllciDquiry< ....
identifJCllion lIIIIIlbc:rllalbecu_r~.bereolI.VVd'!lODcl~227-26IXt,:JJSATlCXBTNO. . .................. .... ......... .... .... ... .... ......
_5.
.',"".".--.-'-: ,," ':-:-,.
'.','..,','-",'--..-.---','. ....:-:-:.........,'......".... ",.' :......
...) B...'.'.....'. ..)::..........: .........AM&:JN'I... H.....:....iuarn NO.
>:ufl4......:..... ....................................~.~.$F..8k.U:...)...: .>..~...........:...... .
.....$- ...
...........................................s.
<<<<":1 J.~-
,. ., -- -- ",." ...--
.-::':-:,:,:, '::::'::::-:::-:-::-::::'::>:::::::,::::::-:--:':':-::'-:-:-:::'.:;-...-::-.::::......
, ,,,.,...,, ',,-- .., - - .
PERMIT APPUCATlON FEE. ......<....)<..........
PLAN CHECK DEPOSIT < .... >........ ....
SECURITY FOR FAmIPUl. PERFORMANCEILABa: MATIiJUALS
CONSTRUCTION CASH DEPOSIT
PLAN CHECK.t: INSPECTION FEE
.-i'
APPROVED FOR ISSUANCE
....,....y
Q