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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date Q2/24/2020 <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.con <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 />1-o r �i r- r o 05N 4Yc� <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 E MARIPOSA RD approximately 880 ee mile SOUTHEAST <br />of E MUNFORD AVE , by performing the following work scription of work): <br />DIG (3)4'X4' PITS, PLACE 395" 1-4" DUCT VIA BORE, PLACE (I)NEW 30"X48" <br />SPLICEBOX# 4315. THE ASSOCIATED TCF IS SUBMITTED WITH THIS PERMIT. PLEASE <br />SEE THE ATTACHED PERMIT DRAWINGS FOR AT&T JOB# A0IQPAT. <br />Work will commence on or about _4119/2020 for approximately 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 />Engiheering <br />Administrator 2/25/2020 <br />Signature of Applicant - le Date <br />M:ICENTRALSERVICESICLERICALIPNB.SV.WKIAASTER,PMENCROACHMENT PERMIT APPLICATION DCC (0903) <br />OFFICE USE ONLY <br />JOB# <br />I.S oo74'- 4 REF # <br />APN <br />1 10 CR # <br />EXP. DATE <br />1 �02 u <br />VALID <br />r9 2a TO S y Zo DRIVEWAYS: <br />STREET <br />,QD. # <br />AREA <br />/tyoAf QUAD <br />TYPE <br />-tY <br />FORMS <br />,- 27 <br />NOTES <br />" �� 4L gf WD�T2vA <br />Gou idyk7'-o -a/A✓ d <br />►�E/JfE/r!r zT <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />1-o r �i r- r o 05N 4Yc� <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 E MARIPOSA RD approximately 880 ee mile SOUTHEAST <br />of E MUNFORD AVE , by performing the following work scription of work): <br />DIG (3)4'X4' PITS, PLACE 395" 1-4" DUCT VIA BORE, PLACE (I)NEW 30"X48" <br />SPLICEBOX# 4315. THE ASSOCIATED TCF IS SUBMITTED WITH THIS PERMIT. PLEASE <br />SEE THE ATTACHED PERMIT DRAWINGS FOR AT&T JOB# A0IQPAT. <br />Work will commence on or about _4119/2020 for approximately 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 />Engiheering <br />Administrator 2/25/2020 <br />Signature of Applicant - le Date <br />M:ICENTRALSERVICESICLERICALIPNB.SV.WKIAASTER,PMENCROACHMENT PERMIT APPLICATION DCC (0903) <br />