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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/21/2021 <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 />A027Z26 <br />The undersi ned hereby applies for ermission to excavate, construct and/or otherwise encroach on County Highway Right-of-Wa on <br />the NO�TH side of r FREMONT ST approximately 36 ee mile WEST <br />of N GOLDEN GATE AVE by performing the following work (-description of work): <br />DIG (1) 4'X4' PIT TO RAISE EXISTING BARREL VAULT TO STREET GRADE IN DIRT. <br />THE TCP IS SUBMITTED WITH PERMIT. PLEASE SEE THE ATTACHED PERMIT DRAWINGS FOR <br />AT&T JOB#A027Z26. <br />Work will commence on or about 1/5/22 for approximately 2 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 />gum ( �c Engineering <br />Administrator <br />Signature of App ant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12/23/2021 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />1/5/2022 TO <br />6/15/2022 DRIVEWAYS: <br />STREET <br />Fremont St. <br />AREA <br />Stockton QUAD <br />NS <br />TYPE <br />Bell Hole <br />FORMS <br />SSMNV, R-29 <br />NOTES <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />A027Z26 <br />The undersi ned hereby applies for ermission to excavate, construct and/or otherwise encroach on County Highway Right-of-Wa on <br />the NO�TH side of r FREMONT ST approximately 36 ee mile WEST <br />of N GOLDEN GATE AVE by performing the following work (-description of work): <br />DIG (1) 4'X4' PIT TO RAISE EXISTING BARREL VAULT TO STREET GRADE IN DIRT. <br />THE TCP IS SUBMITTED WITH PERMIT. PLEASE SEE THE ATTACHED PERMIT DRAWINGS FOR <br />AT&T JOB#A027Z26. <br />Work will commence on or about 1/5/22 for approximately 2 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 />gum ( �c Engineering <br />Administrator <br />Signature of App ant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12/23/2021 <br />Date <br />