97-125
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERMIT
(for working within the
public right-of-way)
Issued ~ d-b/9 7 c~
Permit expires in i2 months
"" ~
,: Permit No.
X-Ref. file
97-125
Application Date ? /? <) / q 7
Application expires in 6 months
APPLICATION - 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 permit is not issued. Application Fee is non-refundable.)
A. Work address or tract #
125 2nd Street at Grant Street
Utility trench location
Redo of Sunken Patch from Previous Main Repair (EMERGENCY)
Q'XLq' cut ln asphaLt
C. Attach four (4) copies of an engineered plans showing the location and extern 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 plan becomes a pan of
this permit.
B. NatUre of work
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 I and 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant San Jose Water Company Telephone 7.7g-7g7g
(prim name)
Address 1221 S. Bascom Ave., San Jose 9512a4HOUR EMERGENCY TELEPHONE NO.
Is this work being done by the property owner at their own residence?
Yes
No
The Applicant/Permittee 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.
The Applicant/Pennittee hereby acknowledges that they have read and understand both the from and back of this permit, and they will inform their contractor(s) of the
information.
Accepted
Jane Leinberger (EMERGENCY VERBAL)
(Applicant/Permittee) (sign)
2/25/97
Date
SPECIAL PROVISIONS
_1. Street shall not be open cut for underground installations. Minimum cuts m!!Y be allowed for connections or exploration holes. Such cuts mav be specificallv
approved bv the Inspector prior to cuttiOl!.
Pavement may be cut for underground installations and must be restored in accordance with the Utility Trench Restoration Standard Details, Method 'A'Backfill,
unless otherwise approved by Inspector.
Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sem to the PubJi<: WorksDepanntelU before starting work.
Per Section 4215 of the Govemrnem Code this permit is not valid for excavations until Underground Service Alen (USA) has been notified and the inquiry
identifICation number has been emered hereon. USA Phonc 1-800-227-2600. USA TICKET NO.
_2.
_3.
_4.
_So
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES
~
f.,(TIL.,
AMOUNT RECEIPT NO.
s.1..} 5' .../ a
$
$
$ a
s IJ Q --'
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFORMANCElLABOR '" MATERIALS
CONSTRUCTION CASH DEPOSIT
PLAN CHECK'" INSPECTION FEE
APPROVED FOR ISSUANCE
DATE:
TO:
FAX#:
FROM:
SUBJECT:
PERMIT #
97 -125
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CITY OF CAMPBELL
Public Works Department
FAX MEMO
April 23, 1997
San Jose Water Co. -- Sandra Luczkowiak or Maurice Cyr
(408) 292-5812
Robert Phillips / Public Works Inspector
Utility Cut Deficiency Report
DEFICIENCY
Regarding the failed trench located at Grant and 2nd street. ApproxiIhatly one
month ago work began in erder to repair the sunken/failed trench section. Crews
started the excavation of the trench line in order to recompact the affected area.
Upon the completion of the days work, cutback was placed with the expectation
that work would resume the following day. To date work has not resumed.
However, a field representative was onsite approximatly two weeks ago to
determine if the water line was leaking.
Please advise us of the status of this work.
Deficiency must be corrected within 10 days. Work must be performed under a current
encroachment permit. Notify Public Works prior to any work being done and for inspections,
by 8:30 a.m. on the day before work is to be done.
Telephone (408) 866-2165 Fax (408) 376-0958
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790