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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD * <br /> TYPE * <br />(Mailing Address) FORMS <br />NOTES <br /> <br />(City, State, Zip Code) <br /> <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br /> <br />Work will commence on or about _____________________________________ 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 />Signature of Applicant - Title Date <br />E:\PUB-SV.WK\MASTER.PS\ENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />9/21/2020 <br />AT&T / VCC PERMITS DESK <br />559-454-3900 g26977@att.com <br />:TCP-Place poles. <br />5555 E Olive av <br />Fresno, Ca. 93727 <br />10/21/20 15 <br />WESTSIDE MANTHEY RD <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; SEE ATTACHMENTS. <br />130'SOUTH <br />BRIGGS AV <br /> POLE PLACEMENT <br />please see attached document for other specific job location & job description. <br />9/22/2020EngineeringAdministrator <br />A01MQ5N