2165 S. Bascom Ave. (75-7)
IN"TER- DEI' .?RT.rlENT2'\L !.IT::NOH2\FrDUl'1
TO: Building D2par'bment
FRON~ Public T'!orks Department
The requjrernen'ts of the Public T70rks Department have
been sa~i8fied for the following development:
APPLIC2\NT
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BUILDIHG ADDRESS__
coUnTY ASSESSOR'S
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DIRE:C'I'OR OF J?UDLIC HOllies
BY_~____
Date.A.ACA~ ]~ _
RECEIPT
CITY OF CAMPBELL
CAMPB!:.LL. CALIFORNIA
NAME
ADDRESS
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REVENUE ACCOUNT NO.
FUND NUMBER ~
00. i3YY~ o MONEY ORDER o CASH
CHECK
90 70--/ DANJG -1I-75 020 ~t.r7S1.00
THIS RECEIPT AUG -4-75 65 020A ** * S9~.OO
MUST BE MACHINE
VALIDATED AND AUG -1I-75 51 020A *** 1 57.00
SIGNED BELOW.
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Than. You
CITY OF CAMPBELL
BY
CITIZEN COpy
January 19, 1976
H. C. Hansen Co., Inc.
965 Bast San Carlos Avenue
San Carlos, California 94070
SUBJECT: Bond #U 89 73 45 - $4,000.00
United Pacific Insurance Company
File #McGlin. 154. Excavation Permit #75-110
Gentlemen:
All street improvements at 2165 Bascom Avenue,
Campbell, California, are constructed or installed satis-
factorily. Accordingly. the City of Campbell accepts the
improvements, and the sUbject bond is hereby released.
Very truly yours,
WILLIAM G. WREN
DIRECTOR OF PUBLIC WORKS
By Frank T. Lewis
Engineering Manager
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IN mAL
8. DATE
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CITY OF CAMPBELL
STREET EXCAVATION PERMIT NO. --; 5=// l
~,le : Yf--~7~ 4)
Pursuant to the terms of Section ~~ the Campbell Municipal Code, a permit to excavate within the public right of
way in the City of Campbell is issued based upon the following conditions:
1. The location of the job and the nature of the work to be done within the public right of way is as follows:
2165 Bascom Avenue - demolition and replacement of city sidewalks
and curbs and qutters.
2. A diagram is attached and thereby made a part to each of these forms showing the location and dimensions of the work and
relating this to existing underground facilities.
3.
Work will begin on
beginning work.
, 19
, or notify the Campbell City Engineer 24 hours before
4. No street shall be closed without full conformance to Section 7106 of the Campbell Municipal Code.
5. Safe crossings shall be maintained in conformance with Section 7105 of the Campbell Municipal Code.
6. (These blanks to be filled in by the City Engineer ONL YI
a. Special Conditions:
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Import backfill material as required by City Engineer.
~-~o Replace existing roadway structural section with equivalent type and thickness of material plus one additional
"- L1 inch of asphalt; or 4 inches asphalt over 12 inches R-78 base rock, whichever is greater.
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Work to be completed prior to occupancy of structure.
Work to be staked 3 feet back of face of curb by a licensed Land Surveyor or Civil Engineer and three copies of
the cut sheets sent to the Public Works Department before starting work.
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I :', ~; 0 Open cutting of pavement will NOT be allowed; all pipes or conduit shall be jacked under existing pavement.
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Deposit (money or bond) required to guarantee restoration of public right of way.
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7. The deposit in 6b above will be returned, in full, upon satisfactory restoration of public right of way.
8. The Permittee hereby agrees, by affixing his 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.
9. Acceptance of the Permit by the named Permittee constitutes acceptance of any and all conditions upon which this Permit
is granted. This Permit does not relieve the Permittee of any obligation to obtain any other Permit required by law.
ACCEPTED
(signature of Permittee) 1"/f~ 5Y3- ~/..6
ADDRESS H. C. Hanson Co., Inc., 965 East San Carlos Av,
check one: Residence ( ) or Business ( I
(date)
San Carlos 94070
APPROV AL:
DESIGN:
ASSOC. CIVIL ENGR.
DATE
OPERATIONS:
ASSOC. CIVIL ENGR. DATE
3 Copies:
Perm ittee
City Inspector
File
.
Permittee must sign, date and forward to City Engineer for approval. Permit is valid only after signed by City.
Permit is not transferable.
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