97-123
CP"\ ,:)F C/.:.!;. ~ =-__
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
E\'CF.():\CH!\:!::~\T ?Er~,::T
(for working within the
public right-of-way)
L;;rr:;' \'0,
97-/23
X-Ref. file
.;2-/.2)97
Application Date ~ ---l1- ::q-r
Application ezpires in 6 mos.
APPUCATlON - Application is hereby IIIIIde for. Public Worb Pamit in II:CIlII'daIIce wilb ~ MIIIIicipa1 Code, SecdoIIIUM. (Applil:lliaD apins in 6111D111bs
If die permills DOt issued. Application Fee is IIOD-ref\mdable.) ~~ ~ ~ ~ ~,~ ,..,...,..,
A.Worhddras ortncl,~r~~ ~~. -~,. H'~1l~1a4~ ~ ~J ~ t
Utility lreDCb IocIlion
..-.of....~~ ~17LJ~
c. __.... (4) ...... of a' p ... -.' .. -. .. .... (4)...... of.. _ __. _ or..... ....
plam IhII1show !be reIalion of tbe propolClCl work to aisq llUface 11III IIIIdrqrauDd iqmIvemaa. WbeD IppI'OVIId by lbe City EqiDeer,IIid JUI becomes. part of
CbiI pamit.
D. All work sball conform to the City of Campbe11 Slandard Spccificl&ioos 11III Daai1s for Public Worts Cooscruaion; lbe GeamI Pamit t'.-titinolf IiIled ClII die reverse
side; 11III the Special Provisions for this permit. listed below. Failure to Ibide by these coadilioIIIlIIII provisioDl may result in job sbut4JwD raJ/0II forfeiIure of Faithful
PerfonDlllCC Sureties 11III cash deposits. (See GeamI Permit CoadiUoas 111III 2.)
The ApplicanllPenniuce hereby acknowlcdacs thIl they bavc read 11III UDdcntand both lbe from 11III bICk of CbiI permit, 11III they will inform Ibeir COIIIlIClDI'(s) of lbe
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(AppI~iJn)
DAILY REPORT
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CANARV. SUPERVISOR
P.NK.OESIGN
C.OLDENROO. L.ABOA CaMP.
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