97-149
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-wa )
. Permit No. 97-149
X-Ref. file
Application Date 4/18/9 7
Application expires in 6 months
APPUCA TION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code. Section 11.04. (Application expires in 6 months
if tbc permit is IIOt issued. Application Fee is non-refundable.)
A. Worle address ortract# W/S of Winchester Blvd., 200 I N/O Campbell Avenue
Utility trench location
EMERGENCY Repair - Sinking trench/main repair 1d~t2 ! ,"0/ cf(j J/Io((
40 sq. ft. cut ln asphalt )o<.r~f/VIJ.
c. Attach four (4) copies of an engineered plans showing the location and extent of the worle, and four (4) copies of the preliminary Engineer's Estimate of worle. The
plans shall show the relation of the proposed worle to existing surface and underground improvements. When approved by the City Engineer. said plan becomes a pan of
this permit.
B. Nature of worle
D. All worle 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. 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
279-7979
Address 1 7. 7. 1 ~
(prim name)
R;:J~l'nm AUF> ~;:Jn .TnC:::F> qSl ?R 24 HOUR EMERGENCY TELEPHONE NO.
Is this worle 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 harm1ess from
any claim or demand for damages resulting from the work covered by this permit.
The Applicant/Permittee hereby acknowledges that they have read and understand both the from and back of this permit, and they will inform their COnlractor(s) of the
information.
Accepted
Jane Leinberger (EMERGENCY VERBAL)
(Applicant/Permittee) (sign)
4/18/97
Date
SPECIAL PROVISIONS
_1.
Street shall not be open cut for underground installations. Minimum cuts !!!!!lbc allowed for connections or exploration holes.. Such cuts may be soecificallv
lIIlDroved bv the InsPector Driorto cuttin)!.
Pavement may be cut for underground installations and must be restored in accordance with the UtilityTrcnch Restoration Standard Dctails. Method 'A' Baclcfin.
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 sent to. the Public WorksDepartmellt before starting work.
Per Section 4215 of the Government Code this permit is not valid for excavations until UndergroundServiccAlen (USA) has been notified and the inquiry
identiflCa1ionnurnber has been entered hereon. USA Phone 1.8O(),227-2600. USA TICKET NO.
f,et (,01.'" r C!-61 ow C4NC. INTO /!.)t'!7")uG.
<l OV-
JI
_2.
_3.
1:~
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES
IYfg
U1IL.
· AMOUNT .
RECEIPT NO.
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFORMANCElLABOR& MATERIALS
CONSTRUCTION CASH DEPOSIT
PLAN CHECK & INSPECTION F
rP
())
APPROVED FOR ISSUANCE
CITY OF CAMPBELL
FIELD ENGINEER I S DAILY REPORT
PROJECT NO.
0f1s vJ:"J;.t-k. BlvP J~O/Y1)'J
~~ Art.
CONTRACTOR: 5J W G
REPORT NO: :l
DATE: 4/2.
WEATHER: ('AIR.
INSPECTOR: K. ~G..5-rfA.LL
ITEM
DESCRIPTION
cc:
PAGE: /
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CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
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CONTRACTOR: e:S ~ W G
PROJECT NO. 91..../ q
REPORT NO: I
DATE: tl/7/ 7
WEATHER: f'AI R
INSPECTOR: K. .vG:.-5""TfALL
ITEM
DESCRIPTION
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cc:
PAGE: I
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