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f <br /> RECEIVED <br /> APPLICATION FOR ENCROACHMENT PERMIT OCT 0 5 2012 <br /> PLEASE PRINT: FRESNO <br /> OMD/DPD <br /> Date 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# __0 j9REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /s" <br /> VALIDZ 0 f i7 DRIVEWAYS: <br /> Pacific Gas & Electric Company STREET ones :�rl *� <br /> AREA QUAD <br /> 8 River Park Place East TYPE -s , <br /> Fresno, CA 95201 r ORMS Aq <br /> r'NOTES <br /> i <br /> e��7Q <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketchS• zq; /--r ; ; Shall be as per <br /> PM 306 Y-fW y current M.U.T.C.D. <br /> Noti€. California supplement. <br /> . 1 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet/mile <br /> of byp ormin the following work(description of work): <br /> Work will commence on or about for approximately days. <br /> 1,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 /> lU 2— <br /> z:::;- <br /> z:::; Signa ure or6eplicant-Title bate <br />