Laserfiche WebLink
A0295MC <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/16/22 <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 <br />(Area Code - Telephone Number) <br />g26977@att.com <br />(Email Address) <br />may <br />SEE ATTACHED <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the EAST side of BRUELLA RD approximately 13 Qfeet/i le SOUTH <br />of 3RD STREET _ LODI by performing the following work (description of work): <br />REMOVE OLD POLE, BREAK AND RESTORE 5 SO FT OF CONCRETE, TRANSFER AERIAL FACILITIES (A0295MC) <br />Work will commence on or after 4/4/22 for approximately 1 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 />Brian E. Schultz p203]9n16-00ie2020350703/16/22 <br />Signature of Applicant - Title <br />Date <br />