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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 01/13/2022 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T CALIFORNIA - VALLEY PERMIT DESK <br />(Applicant Name) <br />1445 VAN NESS AVE <br />(Mailing Address) <br />FRESNO, CA 93721 <br />(City, State, Zip Code) <br />(559) 552-4608 g26977@att.com <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <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 E HAMMER LN approximately 270 ee mile EAST <br />of MARANATHA DR I , by performing the following work (-description of work): <br />DIG (1) 4'X4' PIT, PLACE 13' 24' DUCT VIA TRENCH, PLACE 188' 24" DUCTS VIA BORE. REMOVE & <br />RESTORE 21 SQ FT OF ASPHALT & 40 SQ FT OF CONCRETE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE SEE THE ATTACHED PERMIT <br />DRAWINGS FOR AT&T JOB# A0295GX. <br />Work will commence on or about 3/4/22 for approximately 5 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 />5jfgtu1Jc4,6,Le,, Engineering Administrator <br />Signatur of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />3-3-2022 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />5t4t 022 <br />4M 5i2e22 <br />TO <br />DRIVEWAYS: <br />STREET <br />am�175- <br />AREA <br />SLOCkLon <br />QUAD NVV <br />TYPE <br />ire, <br />Trenc eF RTLoncret@ <br />FORMSSS!vvvv,, <br />rench CutPolicy <br />NOTES <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <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 E HAMMER LN approximately 270 ee mile EAST <br />of MARANATHA DR I , by performing the following work (-description of work): <br />DIG (1) 4'X4' PIT, PLACE 13' 24' DUCT VIA TRENCH, PLACE 188' 24" DUCTS VIA BORE. REMOVE & <br />RESTORE 21 SQ FT OF ASPHALT & 40 SQ FT OF CONCRETE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE SEE THE ATTACHED PERMIT <br />DRAWINGS FOR AT&T JOB# A0295GX. <br />Work will commence on or about 3/4/22 for approximately 5 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 />5jfgtu1Jc4,6,Le,, Engineering Administrator <br />Signatur of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />3-3-2022 <br />Date <br />