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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/12/2020 <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 W LEHMAN AVE approximately 804 ee mile SM/ <br />of AHERN RD 3514 W LEHMAN RD by performing the following work (-description of work): <br />DIG (4) 4'X4' PTTs, PLACE 470'2-1.25" INNERDUCTS VIA BORE. REMOVE & RESTORE 8 SQ FT <br />OF ASPHALT. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE SEE THE ATTACHED <br />PERMIT DRAWINGS FOR AT&T JOB# A01 XHRZ. <br />Work will commence on or about 1173o for approximately 5 DAYS 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 />Engineering <br />C/ Administrator <br />Signature of Applicant - e <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />11/09/2020 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079-4 REF # <br />APN <br />CR # <br />EXP.DATE <br />3/1/2021 <br />VALID <br />11/30/2020 TO 3/1/2021 DRIVEWAYS: <br />STREET <br />Lehman Ave. <br />AREA <br />Tracy QUAD SW <br />TYPE <br />Bell Holes, Bores <br />FORMS <br />SSANW, 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 W LEHMAN AVE approximately 804 ee mile SM/ <br />of AHERN RD 3514 W LEHMAN RD by performing the following work (-description of work): <br />DIG (4) 4'X4' PTTs, PLACE 470'2-1.25" INNERDUCTS VIA BORE. REMOVE & RESTORE 8 SQ FT <br />OF ASPHALT. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE SEE THE ATTACHED <br />PERMIT DRAWINGS FOR AT&T JOB# A01 XHRZ. <br />Work will commence on or about 1173o for approximately 5 DAYS 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 />Engineering <br />C/ Administrator <br />Signature of Applicant - e <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />11/09/2020 <br />Date <br />