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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/16/2021 <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 />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Wa on <br />the SOUTH sideof THIRTEENTH ST E approximately 77 ee mile EASY <br />of S B ST , by performing the following work (-description of work): <br />ACCESS EXISTING POLE#6 TO PLACE (1) NEW 10' GND BED IN DIRT. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE SEE THE ATTACHED <br />PERMIT DRAWINGS FOR AT&T JOB# A028P56. <br />Work will commence on or about 01/12/2022 <br />for approximately <br />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 Administrator <br />Signaturlirof Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12-30-2021 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />1/12/2022 <br />TO 5/1/2022 DRIVEWAYS: <br />STREET <br />Thirteenth St. <br />AREA <br />Stockton <br />QUAD SS <br />TYPE <br />Ground Bed <br />FORMS <br />SSNM <br />NOTES <br />-Special <br />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-Wa on <br />the SOUTH sideof THIRTEENTH ST E approximately 77 ee mile EASY <br />of S B ST , by performing the following work (-description of work): <br />ACCESS EXISTING POLE#6 TO PLACE (1) NEW 10' GND BED IN DIRT. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE SEE THE ATTACHED <br />PERMIT DRAWINGS FOR AT&T JOB# A028P56. <br />Work will commence on or about 01/12/2022 <br />for approximately <br />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 Administrator <br />Signaturlirof Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12-30-2021 <br />Date <br />