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p5_ 106u2d <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date l,, OFFICE USE ONLY <br /> To. San Joaquin County JOB# 13 n®'73-3 REF# <br /> Department of Public Works APN _ CR# ---j <br /> � EXP.DATE p -- <br /> I ` VALID TO // ! DRIVEWAYS: i <br /> (Applicant Name) STREET ; <br /> �Q AREA �� 'a_�QUAD N,00 <br /> TYPE e 'ze --- <br /> (Mailin Address) +/� FORMSfyy9 - ' <br /> q ZL��� NOTES _�'� -------� <br /> i <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may besubmitted) <br /> The un si d hereby applies for permission to excavate,construct and/or otherwise encroach ori County Highway Right-of-Way on <br /> side of 1Q [!?Armor P approximate/ <br /> Y--- %----.-----feet/mile <br /> of -� by performing the following work description of work): <br /> AT&T proposes to install a new Aerial poleline consisting of approx 12 new solely owned poles along the north side of W Barber Rd <br /> within the existing 60'ROW,from the east side of the intersection of Blossom Rd&W Barber Rd heading approx 2,500'west to 11090 <br /> W Barber Rd.,an existing AT&T cell site.. AT&T also proposes to replace approx 8 existing damaged or leaning poles along Walnut <br /> Grove Rd. See attached drawings for more information. <br /> Work will commence on or about gyp—//—l�'j _ _ for approximately � _ days. <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 Y T>6",oto ����" <br /> Sign re of scant-Title / Dates <br /> erg,esv.r,�a,a=s.Fncnv,;aaFna_w�,-av�,cn.rroo� m:n, <br />