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RECLAIWI13 FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OCT 0 5 201? <br /> Date 10/5/2012 OFFICE USE ONLY <br /> FRESNO <br /> To: San Joaquin County OMD/DPD JOB# �,3 ��" REF# <br /> Department of Public Works APN CR# <br /> PG&E (KAMRAN VAHABI) EXP.DATE <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET W. <br /> AREA QUAD 4576 <br /> 8 RIVER PARK PLACE EAST TYPE T:Fu. Rows B2%/- ;; <br /> E <br /> (Mailing Address) FORMS �.J�' �f a �� <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 56, 57, 77 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 SOUTH side of MARIPOSA RD approximately 100 ' feet/mile NORTH <br /> of MUNFOR RD , by performing the following work(description of work): <br /> EXCAVATE 2 BELL HOLES AND INSTALL 1,215'OF GAS MAIN <br /> ONE BELL HOLE AT 100'NORTH OF MUNFOR RD FOR MAIN TIE-ION.ONE BELL HOLE AT 370'NORTH OF MUNFORD FOR SERVICE TRANSFER <br /> Work will commence On Or about SCHEDULE TO BE DETERMINED BY CALTRANS for approximately 2 WEEKS 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 (01/08) <br />