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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 03/05/2020 <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.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 />Engineer: <br />PORFIRIO OSNAYA <br />(209) 549-5832 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EAST side of S AUSTIN RD approximately 79 9sycription <br />mile NORTH <br />of ARCH RD , by performing the following work of work): <br />ACCESS SPLICEBOX#1 TO SPLICE EXISTING FIBER CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT FOR AT&T JOB# A0ISQSV. <br />Work will commence on or about 4!912020 for approximately 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 />M <br />INEERINGINI TRATOR 3/06/2020 <br />Signature of Applic90 Title Date <br />MACE NTRALSE RNCESICLERICAUPOB-S9.WRP+(ASTER.P5$NCR0ACKiENT PERMIT APPLICATION.000 (WAJ) <br />OFFICE USE ONLY <br />JOB # <br />73009REIF # <br />APN <br />CR # <br />EXP, DATE <br />l�lv <br />VALID <br />4 4 Zo Tb 5 /.q zu DRIVEWAYS: <br />STREET <br />AREA <br />QUAD 5� <br />TYPE <br />s�%wr✓ <br />FORMS <br />w -56EC)AL 6d4-),DMb�S �• <br />NOTES <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />Engineer: <br />PORFIRIO OSNAYA <br />(209) 549-5832 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EAST side of S AUSTIN RD approximately 79 9sycription <br />mile NORTH <br />of ARCH RD , by performing the following work of work): <br />ACCESS SPLICEBOX#1 TO SPLICE EXISTING FIBER CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT FOR AT&T JOB# A0ISQSV. <br />Work will commence on or about 4!912020 for approximately days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />M <br />INEERINGINI TRATOR 3/06/2020 <br />Signature of Applic90 Title Date <br />MACE NTRALSE RNCESICLERICAUPOB-S9.WRP+(ASTER.P5$NCR0ACKiENT PERMIT APPLICATION.000 (WAJ) <br />