97-138
CITY OF CAMPBELL
DEPT OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-D958
ENCROACHMENT PERMIT
(for working within the
public right-of-way) ~
Issued .4 J3 JCJ 7
Permit expires in 12 mos.
T' nit No.9 7-/38
.ef. File
Application Dat!:>/:;;"ro )97
Application expires in 6 mos.
A. Work address or tract #
Utility trench location
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).
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B. Nature of work
INSfl(.1
S.D. # d--f 6- B.r90 7
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~\~~'Eut Conditions
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by thesee>rGo~ani:l provisions may result in
job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit.nlftions 1 an\2~ ~
E. TIIE CONTRACTOR MUST HA VB TIllS PERMIT AND APPROVED PLANS AT TIIE SITE AND MU~ TIIE pUBUC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC Wq~'A T~ 24 HOURS
BEFORE RESTARTING ANY WORK. <' 0.,) :~~\C;;\~
).'01"1
Name of ApplicantlPermittee Pacifi c Gas & El ectri c Company Telephone (408) 725-2022
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 ApplicantIP~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.
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RECEIVED
MAR 2 61997
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