97-107
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
lNCROACHMENTP~
,for working within the
public right f-way)
P t No.
X-l,-"i. File
9'7 -/07
/
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CJ. ?-t .:-ctL
Application Date 1- ,~ - // Ii 7
Application expires in 6 mos. I ~
APPUCATION - 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 pennit is not issued Application Fee is non-refundable).
A.Workaddressortract# /tb8! &.cK.~LL lfoUJ ileus€... 7V X lLrIol-ISf'~
Utility trench location /lIo.er1I .8cAc..~;VA L.I- ~: ~/O WC5/7)IV
B. Natureofwork 4/~4' &LLf1t;u: ro CdT-CFF GAs 56etkce: S.D. # 4IC:1'r.5:JL6
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 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 shuHlown and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.)
E. TIlE CONTRACTOR MUS!' HA VB THIS PERMIT AND APPROVED PLANS AT TIlE SITE AND MUS!' NOTIFY TIlE PUBUC WORKS
DEPARTMENT AT LEASf TWO DAYS BEFORE srARTING WORK. NOTICE MUST, ~E~ TO AUBJ..IC 'YORKS AT LEAST 24 HOURS
BEFORE RESfARTING ANY WORK. Vt....,,(,"" ~/"'"l'C"A>Lre..S)J-1Ajt(j)o/
. . . ~~~ r:vut ....c;"ferl/- ~
Name of Applicant/Permittee Pac 1 fl c Gas & El ectn c Com Telephone (408) 725-2022
Address
Is this work being done by the property owner at their own residence?
No
~I:
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers. agents ~d employls~..,
safe and harmless from any claim or demand for damages resulting from the work covered by this permit. rJlIN 1 $ ff: /)
The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, l,qld they. ,will inf~;i'eir
contractor(s) of the info tion: 't..;IIJ{IN/~ ";';1
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