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APPLICATIONFORENCROACHMENTPERMITJOBEX:A021C7APLEASEPRINT;Date3/25/2021OFFICEUSEONLYTo:SanJoaquinCountyJOB #REF #DepartmentofPublicWorksAPN____________________CR#______________EXP.DATE____________________________AT&T/VCCPERMITSDESKVALIDTODRIVEWAYS:(ApplicantName)STREET________________________________AREAQUAD5555E.OliveAveTYPE_______________________(MailingAddress)FORMS________________________________NOTES___________________________________________Fresno,CA93727(City,State,ZipCode)_________________________________________________________(559)454—4900g26977@att.con____________________________________________(AreaCodeTelephoneNumber)_________________________________________________________Sketch(Detailedplansmaybesubmitted)ACOPYOFTHETRAFFICCONTROLPLANISSUBMITTEDWITHTHISPERMIT;SEEATTACHMENTSTheundersignedherebyappliesforpermissiontoexcavate,conslructand/orotherwiseencroachonCountyHighwayRight-of-WayontheWESTsideofSCHRISMANRDapproximately1850(fmileofBETWEENBATESRDANDVALPICORDbyperformingthefollowingworkcriptionofwork):ACCESSEXISTINGPOLELEADFORFIBERPLACINGANDSPLICING.ALSOACCESSFIBERVAULTFB563ONWSCHULTERDANDSCHRISMANRDFORFIBERSPLICINGWorkwillcommenceonorabout_4/i/2l__________________________forapproximately________14__________days.I,theundersigned,certifythatIamtheowneroftherespectiveproperty,oramqualifiedtorepresenttheownerandagreetodotheworkdescribedaboveinaccordancewiththerulesandregulationsofSanJoaquinCountyandsubjecttoinspectionandapproval.SignatureofApplicant-TitleDateMICENTRMLSERV3CES3GLLRICAL9(UBSVWE9LRSTERPS(ENGROACHMENTPERMITPPI,CATION.DOC(00(13)Engineering Administrator3-25-2021