97-102
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 witbia the
public riaht-of-way) ri9
Issued i/l,+/(j(
Permit expires in 12 months
Permit No. 9 7 -1 0 2
X-Ref. file
Application Date 1/7 /9 7
Application expires in 6 months
APPUCA TlON - Applicaion is bcrdJy IIIIde for . Public worts Permit ill 1l:Cuo...... wiIb Cmpbdl MwIicipII Code, Scaion 11.04. (AppI...... apirc:a ill 6 IIIIlIIlbs
if lbe permit is DOl issued. AppliclUon Fcc is DllIH'dwldIbIc.)
253 West Rincon (x-street South Milton)
A. Work IIIdre:u or Ua:l ,
Utilicy IreDl:h Ioc:aion
B. NIIIIrC of worlc
EMERGENCY Service Repair - 2'x4' cut in dirt
C. AIracb four (<4) copies of an qiDccraI plans sIIowiDa lbe Ioc:.xIa IDIl =- rtllbe wwt, _ f1lur (<4) copies rtllbe prdimiaary BDP-r's IiIIim8 rtl wort. The
plans IhaI1Ibow !be reIaion of lbe proposed wort 10 aistina IIIlfa::c IDIlllllllerpouDd ;mp.G.CIIIaIII. WIaI..,proved by lbe Ciry EDP-, ... pIIII '- . pm of
d1is permit.
D. AD wort shall conform 10 die City of Campbdl Scudard Specit\caioas _ DelailI for Public Worts Coaarucaoa; lbe GcucnI Permit r.-ltW.o liaal OD lbe rewne
side; _ !be Special Provisions for this permit. 1isted below. FIiIure lD mide by lbae CllIIIdilioaI_ provisiDDs may rauII ill job IIIuklowu fIldIor lorfeilurc at FairhfuI
PufonJlllllZ Sun:tia _ cash cIcposits. (See GcucnI Permit r"'lditioas 1_ 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SJTE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 2<4 HOURS BEFORE RESTARTING ANY WORK.
NIIIIC of Applicam San Jose Water Company
1PriIIl name)
~ 1221 S. Bascom, San Jose 95128
TcIcpboor;27 9 -7 9 7 9
2<4 HOUR EMERGENCY TELEPHONE NO.
II d1is work bein& done by lhe property owner at their own residence?
Yes
No
The ApplicanllPerraiacc bereby III'CCS by 1ff'1Xin& their .ipIIIure lD this permit lD bold lhe Ciry of Cmpbdl, ill ofticen. IICIIIS _ ~loyees free, life _ bmDIaI from
any claim or demand for cIamaies resuItini from lhe work covered by d1is permit.
The ApplicanrJPermiace bcrdJy aclaIow1edaes lballhey have real _ lIIlder1WId boch IIIe fraat _ bICli: of d1is permit. _ lhey will inform their ~~s) atllle
iDformalion.
~
Jane Leinberger (EMERGENCY VERBAL)
(App1icanl/Permia=) (silo)
1/7/97
DIIe
._2.
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SPECIAL PROVISIONS . . ._..-......'.... .......,'.........
_1. SUeet shall lICIt be open cut tor~~.~;.,i....... ~J!!!%be~l"clr~alW"~dor~boles'~~~~~~..
lIlDroved bv the IIISDCCIOr Drior 10 c:uttin2. .. .. .,., ,... .,.,:.,.... ...' ."".,.,.. ...." <:. <d"'.':: d. .",:.,,:. . <.,.,.. .....,..,....,., , : "".' ...,..... .."":..,,,.. ,;.".. . ..
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_3. Work 10 be.ualcer:l by . lia:nsed l.aIId SlU'Ieyoror Ori EDaiD= IIId two a)copiaGf _ cutsbaets _ tDJbePWfic Worb~ tlc!Ift~wmL
_4. Pl:r. Scction4215 ofllle GovcrnmcmCodelhS permit is lICIt YIIIid for ~ lIIIIil U~ Servi= ~~)..bIlalDlDfiedlDlfdleiaquiry..
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PERMIT APPUCATlONFEE
PLAN CHECK.DEPOSIT
SECURITY FOR FAITHFUL l'ERF'ORMANCWt..a:. MATIiRJAl..S... ..
CONSTRUCTION CASH DEPOSIT
PLAN CHECJt a: INSPECTION FEE
APPROVED FOR ISSUANCE