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PLEASE PRINT: t' <br /> I'ViT CROACHMENT PERMIT <br /> OC <br /> Date .10/5/2012 T 0 5 2012 OFFICE USE ONLY <br /> To: San Joaquin County FRESNO JOB# REF# <br /> Department of Public Works OMD/DPD APN CR# <br /> PG&E (KAMRAN VAHAB I) EXP.DATE f * <br /> VALID TO 4h113 DRIVEWAYS: <br /> (Applicant Name) STREET , rQD, <br /> AREA 5MckWAJ QUAD ALS <br /> 8 RIVER PARK PLACE EAST TYPE 14,80.(ES B64ES <br /> (Mailing Address) FORMS �t! — ' <br /> NOTES <br /> FRESNO, CA, 937210 <br /> (City,State,Zip Code) <br /> 559-347-5052 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> CONFLICTS 58 START CONSTRUCTION: 11-1-12 <br /> END CONSTRUCTION: 12-31-13 <br /> SEE ATTACHED DRAWING. <br /> PM 30649126 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach'on County Highway Right-of-Way on <br /> the WEST side of HWY 99 approximately AT feet/mile <br /> of SECTION AVE , by performing the following work(description of work): <br /> EXCAVATE 1 BELL HOLES AND INSTALL 15T OF GAS MAIN <br /> ONE BELL IN THE CU-DE-SAC OF SECTION AVE AND APPROXIMATELY 50 OF BORE FALLS WITHIN SAN JOPAQUIN COUNTY R/W <br /> Work will commence on or about SCHEDULE TO BE DETERMINED BY CALTRANS for approximately 1 WEEK days. <br /> (LAST QUARTER OF 2012,FIRST QUARTER OF 2013) <br /> I,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 /> r T ' 10/5/2012 <br /> ,.i_.•.nom..-��J`.�.�.✓ 'J ..�R.�3 <br /> Signature of Applicant-Title Date <br /> E:1PUB-SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.00C (01/08) <br />