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APPLICATIONFORENCROACHMENTPERMITPLEASEPRINT:Date3/0512020To:SanJoaquinCountyDepartmentofPublicWorksAT&T/VCCPERMITSDESK(ApplicantName)5555E.OliveAve(MailingAddress)Fresno,CA93727(City,State,ZipCode)(559)454—4900g26977@att.c(AreaCode-TelephoneNumber)Theundersignedherebyappliesforpermissiontoexcavate,constructand/orotherwiseencroachonCountyHighwayRight-of-WayontheEASTsideofELEVENTHSTapproximately930(&mileSOUTHEASTofLOVELYRD,___________________,byperformingthefollowingwork(dIcriptionofwork):ACCESSMANHOLE#111TOSPLICEEXISTINGFIBERCABLE.PLEASESEEATTACHEDDOCUMENTFORSPECIFICJOBLOCATION&JOBDESCRIPTION:Workwillcommenceonorabout3/26/2020forapproximately10days.I,theundersigned,certifythatIamtheowneroftherespectiveproperty,oramqualifiedtorepresenttheownerandagreetodotheworkdescribedaboveinaccordancewiththerulesandregulationsofSanJoaquinCountyandsubjecttoinspectionandapproval.,2);:-t2ENGINEERINGL1—----ADMINISTRATORAOlSA75Sketch(Detailedplansmaybesubmitted)ACOPYOFTHETRAFFICCONTROLPLANISSUBMITTEDWITHTHISPERMIT;SEEATTACHMENTSDebbieSneedNUMBEROFWORKDAYS-lO(559)739-6646SignatureofAppInt-TitleDate3/05/2020M:CENTRALSERVICESCLERICAL\PUB-SV,WK\MASTER.PSENCROACHMENTPERMITAPPLICATION.DOC(09/13)