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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 03/19/2020 <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.co <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 SSPW John McDowell <br />(209) 578-7155 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the WEST side of CHEROKEE RD approximately 220 ee mile SOUTHWEST <br />of WIGWAM DR by performing the following work Wscription of work): <br />ACCESS MANHOLE# 816 TO SPLICE THE EXISTING FIBER CABLE, <br />THE ATTACHED DOCUMENT FOR SPECIFIC JOB LOCATIONS &JOB DESCRIPTIONS. <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 />,.r*?2G>!LIZ Z� <br />�� Engineering <br />Administrator <br />Signature of Applicant • Titl <br />MILEIIIRN.SERNCE5ICLERICFLIPIIRSV.W1(VMSTFA.PSIFNCROFCHMEMPEHMRPPPIJCFTIONDOL (OR�1]) <br />3/19/2020 <br />Date <br />OFFICE USE ONLY <br />J08 # <br />REF # <br />APN <br />CR # <br />EXP. DATE' <br />1.0 <br />VALID <br />Zo <br />' 20 DRIVEWAYS: <br />STREET <br />EaCIlEE <br />AREA <br />QUAD <br />TYPEK <br />°�om <br />°✓TILS <br />FORMS <br />55 ✓ <br />NOTES <br />cia <br />it/iS <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 SSPW John McDowell <br />(209) 578-7155 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the WEST side of CHEROKEE RD approximately 220 ee mile SOUTHWEST <br />of WIGWAM DR by performing the following work Wscription of work): <br />ACCESS MANHOLE# 816 TO SPLICE THE EXISTING FIBER CABLE, <br />THE ATTACHED DOCUMENT FOR SPECIFIC JOB LOCATIONS &JOB DESCRIPTIONS. <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 />,.r*?2G>!LIZ Z� <br />�� Engineering <br />Administrator <br />Signature of Applicant • Titl <br />MILEIIIRN.SERNCE5ICLERICFLIPIIRSV.W1(VMSTFA.PSIFNCROFCHMEMPEHMRPPPIJCFTIONDOL (OR�1]) <br />3/19/2020 <br />Date <br />