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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10-5-12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE i1 <br /> AT&T CA C/O: ROBERT SCHEPPMANN VALID zz » TO Ithim DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA ';HoeN Z-D1,j QUAD f4w <br /> 2300 E Eight Mile Rd #100 TYPE - R -y3�oelr_- <br /> (Mailing Address) FORMSyy,N, <br /> NOTES <br /> Stockton, CA 95210 <br /> (City,State,Zip Code) <br /> 209-474-4052 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> REFER TO ATTACHED PLANS - <br /> AT&T PROJECT 8643345 Drawing 2 of 2 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> theSouth & East side of W. Barber Rd & Cameron Rd approximately 1,802 feet feet/mile East <br /> of 5 Freeway , by performing the following work(description of work): <br /> Trench & place 223 feet of 2-1.25" buried innerduct, directional <br /> bore under Barber Rd & place 113 feet of 1-4" conduit from pole <br /> P10040 to pole P28525 <br /> Work will commence on or about 10-22-12 for approximately 3 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 /> UiRkeJ NawaRer 10 <br /> re of A licant-Titl Date <br /> EVUB-SV.WIERVROAcHmENT <br /> PERMIT APPLICATIONAOC(81108) <br />