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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: RECEIVED <br /> Date 10/5/2012 OCT U 5 2012 OFFICE USE ONLY <br /> To: San Joaquin County FRESNO JOB# REF# <br /> Department of Public WMDIDPD APN CR# <br /> PG&E KAMRAN VAHABI EAP.DATE /.3 <br /> VALID Z T 3 DRIVEWAYS: <br /> (Applicant Name) STREET KJOA Jeb <br /> AREA CtdGkWQUAD <br /> 8 RIVER PARK PLACE EAST TYPE 1{ 16. <br /> (Mailing Address) FORMS fiVt� —Z <br /> FRESNO, CA, 937210 NOTES <br /> (City,State,Zip Code) <br /> 559-347-5052 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> CONFLICTS 10, 12, 13, 14 & 100 START CONSTRUCTION: 11-1-12 <br /> END CONSTRUCTION: 12-31-13 <br /> SEE ATTACHED DRAWING. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the NORTH&SOUTH side of HWY 99 AND MARIPOSA approximately ALL AROUND feet/mile <br /> of MARIPOSA ON RAMP AT HWY 99 , by performing the following work(description of work): <br /> EXCAVATE BELL HOLES. <br /> ONE BELL HOLE IS WITHIN SAN JOAQUIN COUNTY R/W. <br /> BELL HOLE IS TO RELOCATE EXISTING GAS MAIN TO ACCOMODATE STORM DRAIN INLET ON FRONTAGE RD ON WEST SIDE OF 99 <br /> AT"ROAD Sta 12+50.00,22.0 Lt" <br /> Work will commence on or about SCHEDULE TO BE DETERMINED BY CALTRANS for approximately 2 WEEKS 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 /> z�ar—U`- - 10/5/2012 <br /> Signature of Applicant-Title Date <br /> E:IPUB•SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />