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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 07-12-13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE // / ! _ <br /> AT&T CA C/O: RICH ABALLE VALID 23 TO ItIll-15 DRIVEWAYS: <br /> (Applicant Name) STREET C yU,r <br /> AREA QUAD <br /> 1116 M St TYPE <br /> (Mailing Address) FORMS �' <br /> -2 <br /> NOTES <br /> Modesto, CA 95354 <br /> (City,State,Zip Code) <br /> 209-578-7351 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> REFER TO ATTACHED PLANS &TCP- <br /> AT&T PROJECT 8856308, Dwg 1 of 10 <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 Mac Arthur Dr approximately 58 feet feet/mile North <br /> of Arbor Ave ,by performing the following work(description of work): <br /> 1)Starting from 58'N/0 Arbor Ave, trench in dirt and place 1 buried cable along the east side of <br /> Mac Arthur Dr heading north to Tom Paine Slough 2)Starting from Canal Blvd, trench in dirt and <br /> place 466 feet of 1 buried cable along the west side of Mac Arthur Dr headin north 3) Startinq from <br /> Mae Arthur trench in dirt Ia t of 1 buried ca le along the north side of Delta <br /> -Work will commence on or-about ..._._.. .07_2 -13__......_.__-,_..------_. .__..- <br /> orapproximately- ._.__-_.._..__12-- __-_.,..-.-.days:..__......__._...._...__._ <br /> 1,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 a ve in rdance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 7213 <br /> Sig t re if pplicant-Title ate <br /> E:1PDB SV.YACNWSIER N HH PEWITAPPtlCATION.DOC ptA%j <br />