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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/14/2020 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T 1 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 />A01 RS69 <br />John McDowell <br />(209) 5787155 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroachn County Highway Right -of -Way on <br />the EAST side of LOWER SACRAMENTO RD approximately 4 ee mile SOUTH <br />of MOKELUMNE ST by peiforming the following workscription of work): <br />ACCESS MANHKLE# 181 TO PLACE & SPLICE NEW FIBER CABLE. <br />TCP IN PLACE TO ACCESS MANHOLES, POLES FOR AERIAL FIBER PLACEMENT, ANCHORS <br />& GROUND BEDS. PLEASE SEE ATTACHED DOCUMENT FOR OTHER SPECIFIC JOB <br />LOCATIONS & DESCRIPTION. <br />Work will commence on or aboutfor approximately 2_3 days 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 <br />Administrator 2/14/2020 <br />Signature of Applie9v1itle Date <br />M;ICENTRALSLRVICE=LERICALNNR-SVWNVhASTERPSIENCROACH?dENTPEWdITAPPLICAIWN.6CC (091191 <br />OFFICE USE ONLY <br />JOB # <br />az - A REF # <br />APN <br />CR # <br />EXP. DATE <br />2u <br />VALID <br />320 zv TO Si ?d DRIVEWAYS: <br />STREET <br />S ATri4e 4'-T G�xA:Y S <br />AREA <br />k620410"QUAD 41l.1 <br />TYPE <br />blo4k, Ple nits--af �%1de E3 <br />FORMS <br />e- z 9 7 <br />NOTES <br />,q L lam, fh'b 0-S <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />A01 RS69 <br />John McDowell <br />(209) 5787155 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroachn County Highway Right -of -Way on <br />the EAST side of LOWER SACRAMENTO RD approximately 4 ee mile SOUTH <br />of MOKELUMNE ST by peiforming the following workscription of work): <br />ACCESS MANHKLE# 181 TO PLACE & SPLICE NEW FIBER CABLE. <br />TCP IN PLACE TO ACCESS MANHOLES, POLES FOR AERIAL FIBER PLACEMENT, ANCHORS <br />& GROUND BEDS. PLEASE SEE ATTACHED DOCUMENT FOR OTHER SPECIFIC JOB <br />LOCATIONS & DESCRIPTION. <br />Work will commence on or aboutfor approximately 2_3 days 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 <br />Administrator 2/14/2020 <br />Signature of Applie9v1itle Date <br />M;ICENTRALSLRVICE=LERICALNNR-SVWNVhASTERPSIENCROACH?dENTPEWdITAPPLICAIWN.6CC (091191 <br />