97-146
(TrY OF CAMPBELI/l ~ EN.(;ROACHMENT PERMIT
DBPT. OF PUBUC wom e l,,, for ):Vorking within the
70 North First St. I! jij,blic right-of-way)
Campbell, CA 95008 A& U /" ) I --, ,) n -, ~ ~
(408) 866-2150 "It 1 0 ~ Issued .--t ~ I JiLl .~ Application Date ~ '7
Fax (408) 376-0958 PUbi.lc.. '~, Permit expirel in 12 mos. Application expires in 6 s.
APPUCATION - APPl~~~'Y!~~fR:'de for a Public Works Permit in a' ce with Campbell Municipal Code, Section 11.04. (Application
expires in 6 months if the permit is not ist~ Application Fee is non-refundable).
A. Work address or tract # S~) --r;:.1'1AT 11-001 r.JO &(I"v'a~ VAN-~~) l. T f It-!INc;;\"j>
Utility trench location tJ(\,~:- .4'-L ,-,.)c'f \( (~klL ('-\-'C"J\ ~,
B. Nature of work k-J7 ~ ~ f>~ u;:-::s . (r'Smu..... '~(f\<J~ S. D. #
~-c...o....J<;;)......::T-.iL cIhYL.~
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.
!Y' oc No.
^ _i. File
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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. TIIE CONTRACTOR MUST HA VB THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY TIIE 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 Applicant/Perminee
Pacific Gas & Electric Company
.2046
Telephone (408) 72 5 - CElff
Address 10900 North Blaney Avenue. Cupertino. CA gS014'
Is this work being done by the property owner at their-own residence? Yes No
The App1icant/P~rminee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free,
safe and hannless from any claim or demand for damages resulting from the work covered by this permit.
TIle Applicant/Perminee hereby acknowledges that they-have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the information: