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RECEINED <br /> 0 C T 0 OftNATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: FRESNO <br /> Date 10/5/2012 OMD/DPD <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73e�--s REF# <br /> Department of Public Works APN CR# <br /> PG&E (KAMRAN VAHABI) EXP.DATE91171-5 <br /> VALID !��' .3 0 / 1; DRIVEWAYS: <br /> (Applicant Name) STREET � Vg. <br /> AREA 0=zu� QUAD <br /> 8 RIVER PARK PLACE EAST TYPE ofs 0�0 <br /> (Mailing Address) FORMS ZS <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 /> CONFLICT 1 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 EAST&WEST side of HIGHWAY 99 AT CLARK AVE approximately 25 <br /> pp y feet/mile SOUTH <br /> Of CLARK AVE , <br /> EXCAVATING BELL HOLES. by performing the following work(description of work): <br /> 2 BELL HOLES TO CUT-OFF AND RETIRE EXISTING GAS MAIN UNDER HWY 99. <br /> 3 BELL HOLES TO BORE A NEW 4"STL MAIN UNDER HW 99,APPROXIMATELY 25 FEET SOUTH OF CLARK AVE. <br /> TRAFFIC CONTROL TO BE PROVIDED TWO WEEKS PRIOR TO CONSTRUCTION. <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:IPU&SV.WKIMASTER.PSIENCROACHMENT PERMrr APPLICATION.DOC (01108) <br />