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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/7/23 <br />To: San Joaquin County <br />Department of Public Works <br />PACIFIC BELL TELEPHONE COMPANY DBA AT&T CALIFORNIA/VCC PERMIT DESK <br />(Applicant Name) <br />1445 VAN NESS AVE <br />(Mailing Address) <br />Fresno, CA 93721 <br />(City, State, Zip Code) <br />(559) 552-4608 <br />(Area Code - Telephone Number) <br />g26977@att.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730079 REF # <br />CR # <br />0 DRIVEWAYS: <br />–MafFe—ws Rd. <br />French CaWD SW <br />(2) - Bell Holes <br />SSIMV, K-29 <br />Special L;onditions <br />SEE ATTACHED TCP DRAWINGS FOR AT&T JOB # 15677253. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the NORTH side of W MATHEWS RD approximately 297 _ Q feet/ ()mile WEST <br />of S DELIVERY DR , by performing the following work (description of work): <br />DIG (2) 4'X4' PITS, REMOVE EXIST. SB. LOCATE & EXPOSE EXIST. SPLICE AT 2 LOCATIONS. <br />Work will commence on or after 3/20/23 <br />for approximately <br />12 <br />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 />L6zzl� Z" <br />gnature Applicant - Title Engineering <br />Administrator <br />2/7/23 <br />Date <br />