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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 03/06/2020 <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 q26977@att.corr <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 County Highway Right -of -Way on <br />the EAST side of 99 FRONTAGE RD approximately 1$% ee mile SOUTH <br />of MARFARGOA RD , by performing the following work ( scription of work): <br />ACCESS BARREL VAULT# 4408 TO SPLICE EXISTING FIBER CABLE. <br />Work will commence on or about 4/2712020 for approximately 2 -days days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />i 2 En ineerin Administrator <br />Signatur of Applicant - Title <br />M.4CEIITRALSERVICESICLERICALTUB-SV.WKVMSTERPsIE11CROACHMEIlTPEMIITAPPLICATIOFI.COC X091171 <br />3-9-2020 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />7U71.4 <br />REF # <br />APN <br />CR # <br />EXP. DATE <br />- 1.0 <br />VALID <br />20 TIOS <br />lr 2 a DRIVEWAYS: <br />STREET <br />JED �E) <br />AREA <br />, - � QUAD <br />59 <br />TYPE <br />TG <br />FORMS <br />Wr✓ <br />NOTESgG <br />�TibAiS" - <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach County Highway Right -of -Way on <br />the EAST side of 99 FRONTAGE RD approximately 1$% ee mile SOUTH <br />of MARFARGOA RD , by performing the following work ( scription of work): <br />ACCESS BARREL VAULT# 4408 TO SPLICE EXISTING FIBER CABLE. <br />Work will commence on or about 4/2712020 for approximately 2 -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 />i 2 En ineerin Administrator <br />Signatur of Applicant - Title <br />M.4CEIITRALSERVICESICLERICALTUB-SV.WKVMSTERPsIE11CROACHMEIlTPEMIITAPPLICATIOFI.COC X091171 <br />3-9-2020 <br />Date <br />