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RECEIVED - <br /> FEB 0 6 2012 <br /> APPLICATION FOR ENCROACHMENT PERMIT FRESNO <br /> OMD/DPD <br /> PLEASE PRINT; <br /> Date 01/13/12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas & Electric Company VALID 4 IZ 1r T 4 ii,2 DRIVEWAYS: <br /> (Applicant Name) STREET 5!E0— g-re,%FL-r <br /> p r '" AREA L61>1 QUAD /V j5 <br /> _ R 1`VLK �a�v SC ��11A" L5`� TYPE 'RIL-6 i�EPLACE, <br /> t1ma11,11y T,ddress) FORMS <br /> NOTES --�— <br /> (��ry1 <br /> 916-760-5363 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch <br /> A <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the north side of 3rd St & Cherrywood St approximately feet/mile <br /> of ,by performing the following work(description of work): <br /> Replace joint pole. <br /> Work will commence onor about_ 04/12/12 for approximately 1 days. <br /> l;the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> Michael Reeves - Sr. Engineer 01/13/13 <br /> Signature of Applicant-Title pate <br /> E4'UBSV_Y.7tUMSERP5'EItfR04ChIAFjR P02AUTAPPLItpT101tdOC{OLtIB) <br />