97-129
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CITY OF CAMPBELL - --. ENf"OACHMENT PERMIT Pennit No. / / /\
E~.~~1t:WORKS -i /(f~UC~;)~~lf,~' X-Rf" 11/<.7 ~
(408) 866-2150 -- --....,.J Issued ~ "c I, 1\.-) Application Date 7
Fax (408) 376-025.8...-....- .....~.."J:. ...:.::.~:teqnit exp~ in 12 mos. 0;' !. Q APPI~ expires in 6 os. I
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APPUCATION - Application is hereby made for a Public Works Penrut in accordance with CampbeH Municipal Code. Section 11.04. (Application
expires in 6 months if the pemtit is not issued Application Fee is non-refundable).
A. Work: address or traCt #
Utility trench loca.t1on
8efw-n Re9/;.:t ~ M?/~,- Ave_
Sbvrh _\;d;
(7/1
//t:7///~-/'
B. Namre of work
I-?~p/cce (2) ".0<::::, I/f/e,- r'o/~..r
E7'3855"
S.D. #
C. Aaach 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 worle to existing surface and underground improvements. When approved by
the City Engineer. said plans become a part of this penrut.
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works ConstrUction; the General PemUt 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 andlor forfeiture of Faithful Performance Sureties and cash deposits. (See General Penrut Conditions 1 and 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PUNS AT THE SITE AND MUST NOTIFY THE 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.
Name of ApplicantlPenrunee
Pacific Gas & Electric Company
;lQ40
Telephone (408) 725~
Aadrcss 1 t r
Is ~ work being d~ne by the property owner at metr- own residence? Yes No ~ I'".
The ApplicantIP~nee hereby agrees by affixing their signature to this pemtit to hold the City of Campbell. its officers. :m&faand&mployees ~
safe and hatmicss from any claim or demand for damages resulting from the work covered by this penrut. ,..:~ tJ $ ~
Tlie ApplicantlPemunee hereby acknowleages and understand both the front and back of this ~P.....th~, wiJI inform their
:oncraaor(s) of the information: / 1IVfS'rR41'.,
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