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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/08/2021 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T / VCC PERMITS DESK <br />(Applicant Name) <br />5555 E. Olive Ave <br />(Mailing Address) <br />Fresno, CA 93727 <br />(City, State, Zip Code) <br />(559) 454-4900 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 />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH side of COUNTRY CLUB BLVD approximately 51' ee mile WEST <br />of MARINE AVE , by performing the following work (-description of work): <br />PLACE 3161IX2'X8" CONCRETE PAD, PLACE NEW PFP-432, DIG (2)4'X4' PITS, PLACE <br />36' 1-4" DUCT VIA BORE, PLACE 11' 1-4" DUCT VIA TRENCH. REMOVE & RESTORE <br />32 SQ FT OF ASPHALT. THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. <br />PLEASE SEE THE ATTACHED PERMIT DRAWINGS FOR AT&T JOB# AO1Z247. <br />Work will commence on or about 4/15/2021 through 6/15/2021 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 />102+Ar,1&4, % Engineering Administrator <br />Signatureof Applicant -Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />3-2-2021 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />TO 7,+2021 DRIVEWAYS: <br />STREET <br />—CZUffr77 lvd. <br />AREA <br />btocKton QUAD <br />TYPE <br />Trench, Bore Pits, Bore <br />FORMSbb/VVVV,- <br />-6, H -b, Trenchu oicy <br />NOTES <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH side of COUNTRY CLUB BLVD approximately 51' ee mile WEST <br />of MARINE AVE , by performing the following work (-description of work): <br />PLACE 3161IX2'X8" CONCRETE PAD, PLACE NEW PFP-432, DIG (2)4'X4' PITS, PLACE <br />36' 1-4" DUCT VIA BORE, PLACE 11' 1-4" DUCT VIA TRENCH. REMOVE & RESTORE <br />32 SQ FT OF ASPHALT. THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. <br />PLEASE SEE THE ATTACHED PERMIT DRAWINGS FOR AT&T JOB# AO1Z247. <br />Work will commence on or about 4/15/2021 through 6/15/2021 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 />102+Ar,1&4, % Engineering Administrator <br />Signatureof Applicant -Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />3-2-2021 <br />Date <br />