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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />To: <br />01/31/2020 <br />San Joaquin County Department of Public Works <br />AT&T/VCC PERMIT 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 />JOB# <br />APN EXP.DATE VALID STREET AREA TYPE FORMS NOTES <br />TCP to access AT&T MHs to Rod & Rope only. <br />OFFICE USE ONLY <br />REF# <br />CR# <br />TO <br />QUAD <br />A01MQ5N <br />DRIVEWAYS: • • . <br />Access the following: MH 1141 (37 E. Hospital Rd), MH 408 (7400 S. El Dorado St), <br />SB 939 {221 Manila Rd), SB 2688 (200 Frewert Rd), SB 2687 (39 KLO Rd), <br />SBS 435 (12565 S. Manthey Rd), SB 436 (12715 S. Manthey Rd) <br />Ronald Scarberry <br />(559)454-41 10 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on the side of approximately feet/mile __ _ of Vario11s Locations listed above . by performing the following work (description or work): <br />Work will commence on or about ___ _;:_03.;;_;_/...:..0_27_'2_0_20 _____ for approximatety ___ 1_0 ____ 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 work described above in accordance with th� rules ey.nd regulations of San Joaquin County and subject to inspection and approval. Engmeenng <br />Administrator 01/31/2020 <br />Date