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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date 12/19/2012 <br /> # ����...�°���' REF# <br /> JOB <br /> To: San Joaquin County JOB CR# <br /> Department of Public Works APN <br /> �3 <br /> EXP.DATE DRIVEWAYS: <br /> PG&E (KAMRAN VAHABI) VALID <br /> TO <br /> P STREET <br /> (Applicant Name) AREA ' !-> " QUAD <br /> 8 RIVER <br /> PARK PLACE EAST TYPE <br /> (Mailing Address) FORMSNOTES <br /> FRESNO,O, 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 59 <br /> SEE ATTACHED DRAWING. <br /> PM 30649126 <br /> cavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> The undersigned hereby applies for permission to ex approximately AT feet/Mile---- <br /> the NORTH side of HwY a ,by performing the following work(description of work): <br /> Of OLIVE AVE <br /> EXCAVATE 1 BELL HOLES AND CUT-OFF GAS MAIN <br /> approximately <br /> days. <br /> EDULE TO BE DETERMINED BY CALTRANS for app y 1 WEEK y ' <br /> Work will commence on or about (LAST QUARTER OF 2012,FIRST QUARTER OF 2013) <br /> he respective property,or am qualified to represent the owner and agree to <br /> I,the undersigned,certify that I am the owner oft p <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to Inspectionapproval. <br /> 12/19/2012 <br /> Date <br /> Signature of Applicant-Title <br /> E:1PUB-SV.WK%MASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />