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APPLICA <br /> M&FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> REC3EIVED <br /> Date 10/5/2012 Q C T 0 5 2012 OFFICE USE ONLY <br /> To: San Joaquin County FRESNO JOB# 7Z REF# <br /> Department of Public v1OMDIDPD APN CR# <br /> PG&E (KAMRAN VAHABI) EXP.DATE <br /> VALID /Z,�/3 TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> 8 RIVER PARK PLACE EAST TYPE <br /> (Mailing Address) FORMS <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 73, 74 START CONSTRUCTION: 11-1-12 <br /> SEE ATTACHED DRAWING. END CONSTRUCTION: 12-31-13 <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 approximately 350' feet/mile NORTH <br /> of LOOMIS RD , by performing the following work(description of work): <br /> EXCAVATE 2 BELL HOLE.RELOCATE EXISTING GAS MAIN TO ACCOMODATE DRAIN INLETS <br /> Work will commence on or about SCHEDULE TO BE DETERMINED BY CALTRANS for approximately 2 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 /> -• �`- -= - -� 10/5/2012 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />