97-154
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERMIT
(f ~ng witllln tile
.~ight-of-way)
r----,
issued S'" - 8 - qi Q1ir0
Pennit expires in 12 mos. (/
PermIt No
X-R6
<4, ~ 15L-t
"j
Application Date .} /1 It:; '7
Application expires in 6 mos.
APPLICA TlON - Application is hereby made for a Public Works Pennit in accordance with Campbell Municipal Code, Section 11.04. (Application
expires in 6 months if the pennit is not issued Application Fee is non-refundable).
A. Work address or tract # ~C:-fi. 888~
Utility trench location. II. .ro t.J /.. liE I AJoIlrJ./ 0": C,VIC, CFAffEl l)~
B. Nature of work IAlrnL(. M41NJ; /-!YOfJ.lIAff..J1 DIlV/ccr 4 All> j::;LL. / I'E'A.V/a
RECEIVED
MAY 62199"r
l-'Ul:lLK VV UI"l\~
C. Attach four (4) copies of engineered plans showing the location and extent of the work, and four (4) copies of the~~~s
Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by
LlJe CIty Engineer, said plans b~ome a part of this pennit.
D. All work shall confonn to the City of Campbell Standard Sp~ifications and Details for Public Works Construction; the General Pennit Conditions
listed on the reverse side; and the Sp~ial Provisions for this pemlit, listed below. Failure to abide by these conditions and provisions may result in
job shut-down and/or forfeiture of Faithful Perfonnance Sureties and cash deposits. (See General Pennit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTlFY THE PUBLIC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTlCE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS
BEFORE REST ARTlNG ANY WORK.
Name of ApplicantlPenniuee
Telephone 2. 79 -784- 7
Address 0 t1
Is thiS work being done by the property owner at their own residence?
9~/2
Yes No
The ApplicanlfPennittee hereby agrees by affixing theIr signature to tillS pennit to hold the City of Campbell, its officers, agents and employees free,
safe and hannJess from any claim or demand for damages resulting from the work covered by this pennit.
/ Mil '{ /1'! 7