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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/29/20 <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.com <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 />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the SOUTH side of ARBOR AVE approximately 1,448 ee mile EAST <br />of S HOLLY DR , by performing the following work (3rscription of work): <br />DIG (2) 4'X4' PITS TO LOCATE & INTERCEPT EXISTING 1-4" STEEL DUCT & PLACE (2) WYE <br />CAST, DIG 04'X4' PIT TO PLACE NEW 171 HANDHOLE, PLACE 34'3-1.25" INNERDUCTS <br />VIA BORE. PLACE 64'1-4" DUCT VIA TRENCH. PLACE NEW 10' GND BED IN DIRT. THE <br />DRAWINGS FOR AT&T JOB# A01XROP. <br />Work will commence on or about 11/30/2020 for approximately 7 <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 />Engineering <br />U�2�2rL �ci Administrator 10/30/2020 <br />Signature of Applicant - Title Date <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />OFFICE USE ONLY <br />JOB # <br />730079-4 REF # <br />APN <br />CR # <br />EXP.DATE <br />1 <br />VALID <br />1 113012020TO 1/1/2021 DRIVEWAYS: <br />STREET <br />Arbor Ave. <br />AREA <br />Tracy QUAD SW <br />TYPE <br />Bell Holes, Bore, Trench <br />FORMS <br />SS/WW, R-29, Trench Cut Policy <br />NOTES <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the SOUTH side of ARBOR AVE approximately 1,448 ee mile EAST <br />of S HOLLY DR , by performing the following work (3rscription of work): <br />DIG (2) 4'X4' PITS TO LOCATE & INTERCEPT EXISTING 1-4" STEEL DUCT & PLACE (2) WYE <br />CAST, DIG 04'X4' PIT TO PLACE NEW 171 HANDHOLE, PLACE 34'3-1.25" INNERDUCTS <br />VIA BORE. PLACE 64'1-4" DUCT VIA TRENCH. PLACE NEW 10' GND BED IN DIRT. THE <br />DRAWINGS FOR AT&T JOB# A01XROP. <br />Work will commence on or about 11/30/2020 for approximately 7 <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 />Engineering <br />U�2�2rL �ci Administrator 10/30/2020 <br />Signature of Applicant - Title Date <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />