97-118
ENCROACHMENT PERMIT
, (for' working within the
public right-of-way) r:'1
Issued ~J;;Lg)7 ~ "-'
Fax (408) 376-0958 PUBLIC W l.ll<.l{;' Permit expires in 12 mos. Application expires in 6 mos.
ADMINISTRATION
APPUCATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04.
expires in 6 months if the permit is not issued Application Fee is non-refundable).
ClfY OF CMW3Ij.L~ I! I V E ,c.
DEPT. OF PUilI<CVI1IiIilI(J; P.l
70 North First St.
Campbell, CA 95008 Fee 121991
(408) 866-2150 -
'lit No,
.ef. File
97-/lt
Application Date
J:.-1cJ.-91
,
(Application
A. Work address or tract #
Utility trench location
1'300
Af J3~~v.:-
p ~ T 10 L' l~\ \i E
or- _)I~ r:.W~LK. d--.l
H !:.RR.fQ.T Ll=lN E.
B. Nature of work i.J.J ~ Q "\
.J.,E.CL
G-n ~,
-5IP.....v1c(
S.D. #
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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 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. TIlE CONTRACTOR MUST HA VB THIS PERMIT AND APPROVED PLANS AT TIlE SITE AND MUST NOTIFY TIlE 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. 2.0 /! ~;
Name of Applicant/Pennittee
Pacific Gas & Electric Company
Telephone (408) 725-2)a
Address 10900 North B1 aney Avenue. Cuperti no. CA 95014'
Is this work being done by the property owner at their-own residence? Yes No
The Applicant/P~rmittee 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.
TIle Applicant/Permittee here y acknowledges that they-have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the inti n:
2. - f () " 9 '7
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APPROVE,D F()h~- (::C)NSTRUCTION~
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