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APPLICATION FOR ENCROACHMENT PFRMT <br />PLEASE PRINT: <br />Date 2120120 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T/DBA PACIFIC BELL <br />(Applicant Name) <br />5555 E OLIVE AVE <br />(Ntiling Address) <br />FRESNO, CA 93727 <br />(City, State, Zip Code) <br />559-454-3831 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Please see attached TCP for AT&T project AOIAFNR. AT&T to place underground and aerial <br />fiber from the manhole on S Lammers and Schulte west down Schulte Rd. <br />Michael McCarty <br />(209) 474-4774 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the Northwest side of W Schulte Rd and S Lammers _ approximately 135 ft feet, -West <br />of s Tnmmers Rd by performing the following work (description of work): <br />Placing underground cable from the manhole on. Schulte Rd West of S Lammers continuing aerial West down Schulte Rd. <br />Work will commence on or about 2/28120 <br />for approximately <br />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 2120120 <br />Administrator <br />Signature ofApplic -Title Date <br />1,110ENTRALSERVCEGICLERICAL4PIIBWW WASTERMENCROACHMENT PERMIT APPLICATION DOC 109113 <br />OFFICE USE ONLY <br />JOB # <br />1,4yo j - REF # <br />APN <br />CR # <br />EXP. DATEI <br />S -o <br />VALID <br />-EoZo Td qliqLa DRIVEWAYS: <br />STREET <br />x yuCTE oy. <br />AREA <br />17.4 e- y QUAD SSI <br />TYPE <br />4,e ,91_ kiogk s TGe <br />FORMS <br />�✓ <br />NOTES <br />0J <br />Sketch (Detailed plans may be submitted) <br />Please see attached TCP for AT&T project AOIAFNR. AT&T to place underground and aerial <br />fiber from the manhole on S Lammers and Schulte west down Schulte Rd. <br />Michael McCarty <br />(209) 474-4774 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the Northwest side of W Schulte Rd and S Lammers _ approximately 135 ft feet, -West <br />of s Tnmmers Rd by performing the following work (description of work): <br />Placing underground cable from the manhole on. Schulte Rd West of S Lammers continuing aerial West down Schulte Rd. <br />Work will commence on or about 2/28120 <br />for approximately <br />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 2120120 <br />Administrator <br />Signature ofApplic -Title Date <br />1,110ENTRALSERVCEGICLERICAL4PIIBWW WASTERMENCROACHMENT PERMIT APPLICATION DOC 109113 <br />