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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/08/2021 <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 />FOR AT&T JOB# A027BX7. <br />A027BX7 <br />The unWEST d hereby applies for permission to excavate, construct and/or otherwise encroach Q%County Highway Right -of -Way on <br />the side of S SINCLAIR AVE approximately 1lyy ee mileNORTH <br />of SECTION AVE , by performing the following work (-description of work): <br />SO FT OF ASPHALT. SEE A ACHED PERMIT DRAWINGS FOR AT&T JOB# A027BX7. <br />Work will commence on or about 0310 11202 2 to 0410 11202 2 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 />Engineering <br />Administrator <br />Signature of Applicant - tle <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12/08/2021 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />3/1/2022 TO 5/1/2022 DRIVEWAYS: <br />STREETinch <br />AREA <br />Stockton QUAD ES <br />TYPE <br />Bore Pits, Bores <br />FORMS <br />SSAVW, R-29, Trench Cut Policy <br />NOTES <br />S eci8i Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT <br />FOR AT&T JOB# A027BX7. <br />A027BX7 <br />The unWEST d hereby applies for permission to excavate, construct and/or otherwise encroach Q%County Highway Right -of -Way on <br />the side of S SINCLAIR AVE approximately 1lyy ee mileNORTH <br />of SECTION AVE , by performing the following work (-description of work): <br />SO FT OF ASPHALT. SEE A ACHED PERMIT DRAWINGS FOR AT&T JOB# A027BX7. <br />Work will commence on or about 0310 11202 2 to 0410 11202 2 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 />Engineering <br />Administrator <br />Signature of Applicant - tle <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12/08/2021 <br />Date <br />