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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 05/17/2021 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Bell Telephone Company dba AT&T, VCC Permit Desk <br />(Applicant Name) <br />5555 Olive Ave <br />(Mailing Address) <br />Fresno, CA 93727 <br />(City, State, Zip Code) <br />559-454-4900 <br />(Area Code - Telephone Number) <br />g26977@aft.com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPEetr�a5inet <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730079 REF # <br />CR # <br />b1Z41ZUZ 1 TO DRIVEWAYS: <br />01 o Ave. <br />CCKton QUAD ES <br />&rend—F <br />rent u o icy <br />Special Conditions <br />SEE ATTACHED PERMIT DRAWING NUMBER A01Z6VD <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 S. ORO AVE. approximately 121 FT feet/mile SOUTH <br />of HORNER AVE. , by performing the following work (description of work): <br />PLACE RETROFIT PFP-864 CABINET (64.75"X57.5"X18"), TRENCH 44' OF 14" DUCT FROM <br />PFP TO POLE #722 <br />TCP TO ACCESS 3 POLES ALONG S. ORO AVE N/O HORNER AVE TO S/O HORNER AVE <br />SEE TCP DRAWING FOR EXACT POLE LOCATIONS <br />Work will commence on or after 05/24/2021 for approximately 10 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 />ignature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />5-17-2021 <br />Date <br />