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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County JOB # REF # <br />Department of Public Works APN CR # <br /> EXP. DATE <br /> VALID TO DRIVEWAYS: <br />(Applicant Name)STREET * <br /> AREA QUAD * <br />TYPE * <br />(Mailing Address) FORMS <br />NOTES <br /> <br />(City, State, Zip Code) <br /> <br /> <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br /> <br /> <br />Work will commence on or about _____________________________________ 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 />Signature of Applicant - Title Date <br />E:\PUB-SV.WK\MASTER.PS\ENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />04/07/2021 <br />AT&T/VCC Permit Desk <br />5555 E Olive Ave <br />Fresno, CA 93727 <br />(559) 454-4900 G26977@ATT.COM <br />N. WebsterWest 553 Ft WestDel Rio Dr <br />TCP to Access for placeing & Splicing Aerial Fiber for (6) Poles, & for accessing (5) splice boxes at <br />Towery Ct, Plymouth Rd,. Plymouth Oaks Ct, De Ovan Ave, La Jolla Dr. <br />05/01/2021 to 06/01/2021 5 <br />EngineeringAdministrator 04/08/2021 <br />A020NGY