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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: RECEIVED <br /> Date 10/5/2012 OCT 0 5 Z02 OFFICE USE ONLY <br /> To: San Joaquin County FRESNO JOB# 71,Oe2-S REF# <br /> Department of Public WOOD/DPD APN 0 CR# <br /> 1 <br /> PG&E (KAMRAN VAHAB I) EAP.DATE I <br /> VALID 2 TO ( DRIVEWAYS: <br /> (Applicant Name) STREET � <br /> AREA QUAD <br /> 8 RIVER PARK PLACE EAST TYPE OR116u,Ro s 1 sw"3 <br /> (Mailing Address) FORMS WkJW Z 61 D 11LJ <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 26, 65 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 NORTH side of MUNFORD RD approximately 1340 FEET feet/mile EAST <br /> of E. FRONTAGE RD , by performing the following work(description of work): <br /> EXCAVATE 2 BELL HOLES AND INSTALL 380'OF GAS MAIN <br /> 2 BELL HOLES AT 1340'AND 1720'EAST OF E.FRONTAGE RD ON MUNFORD RD <br /> INSTALL 385'OF 8"GAS MAIN UNDER BRANCH CREEK <br /> Work will commence on or about SCHEDULE TO BE DETERMINED BY CALTRANS for approximately 3 DAYS 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 /> � - - f 10/5/2012 <br /> Signature of Applicant-Title Date <br /> E:IPU&SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br />