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RECEqVEDOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OCT 0 5 2012 <br /> Date 10/5/2012 OFFICE USE ONLY <br /> FRESNO <br /> To: San Joaquin County OMD/DPD JOB# 7?-� ,.rte" REF# <br /> Department of Public Works APN CR# <br /> PG&E (KAMRAN VAHABI) EXP.DATE <br /> VALID ? 0 DRIVEWAYS: <br /> (Applicant Name) STREET i C1I <br /> 8 RIVER PARK PLACE EAST AREA fte4Z@" QUAD <br /> TYPElac-l,Ll�p1, <br /> (Mailing Address) FORMS �y ,��4' ` <br /> FRESNONOTES / <br /> 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 70 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 WEST FRONTAGE RD <br /> of LOOMIS RD approximately 100' feet/mile SOUTH <br /> by performing the following work(description of work): <br /> EXCAVATE 2 BELL HOLE AND INSTALL 400'PF 4"GAS MAIN. <br /> TWO BELL HOLES AT 100'AND 500'SOUTH OF LOOMIS RD AND INSTALL 400'OF PLASTIC MAIN, 15'BELOW DUCK CREEK <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 /> �; l.� 10/5/2012 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />