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REeE4VIEDNCROACHMENT PERMIT <br /> PLEASE PRINT: OCT 0 5 2012 <br /> Date 10/5/2012 OFFICE USE ONLY <br /> FRESNO <br /> To: San Joaquin County OMD/DPD JOB# -3 �-� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 13 <br /> PG&E (KAMRAN VAHABI) VALID 1 3 To 113 DRIVEWAYS: <br /> (Applicant Name) STREET %Qq TJ V90"l <br /> AREA S-mcicMak QUAD <br /> 8 RIVER PARK PLACE EAST TYPE 15i.L <br /> (Mailing Address) FORMS ,�_z�'_? OWcy <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 75 <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 FRONTAGE RD approximately 300' feet/mile SOUTH <br /> of MARIPOSA RD , by performing the following work(description of work): <br /> EXCAVATE 4 BELL HOLES AND INSTALL 275'OF GAS MAIN <br /> 17- CtortetZ•31 • t <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 /> - � - � 10/5/2012 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />