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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/15/2022 <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 />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 />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />A028 P51 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on <br />the NORTH side of E KETTLEMAN LN approximately 2 Geetbile EAST <br />of ATKINS RD , by performing the following work ( escription of work): <br />DIG (1) 4'X4' PIT IN DIRT, PLACE 40' 1-4" CONDUIT VIA BORE; DIG (1) 4'X6' PIT IN DIRT, PLACE <br />3'X5' SPLICE BOX IN DIRT. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. SEE THE ATTACHED PERMIT <br />DRAWINGS FOR AT&T JOB# A028P51. <br />Work will commence on or about 03/01/2022 for approximately 4 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 />Engineering <br />Administrator <br />Signature of Appli nt - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />02/15/2022 <br />Date <br />