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REC&I'VEaR ENCROACHMENT PERMIT <br /> PLEASE PRINT: 0 C T 0 5 Z01Z <br /> Date 10/5/2012 VRESNO OFFICE USE ONLY <br /> �j1Q�� <br /> To: San Joaquin County OMD/DPD JOB# � REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l <br /> PG&E (KAMRAN VAHAB I) VALID O 3 DRIVEWAYS: <br /> (Applicant Name) STREET 2"2 <br /> AREA �Tt�,kTdx/ QUAD /V <br /> 8 RIVER PARK PLACE EAST TYPE '-LL #U116s 13� <br /> (Mailing Address) FORMS 9:5 l✓ , –Z9 v <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 61 , 62, 100 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 GOLDEN GATE AVE approximately 40' feet/mile NORTH <br /> of GUERNSEY AVE , by performing the following work(description of work): <br /> EXCAVATE 2 BELL HOLE AND INSTALL 400'PF 4"GAS MAIN. <br /> ONE BELL 40'NORTH OF GUERNSEY FOR MAIN TIE-IN AND ONE BELL HOLE ON THE S/W CORNER OF THE INTERSECTION TO RELOCATE <br /> EXISTING MAIN TO ACCOMODATE DRAIN INLET <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 /> ~wry ryy+r J - 10/5/2012 <br /> Signature of Applicant-Title Date <br /> E'IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />