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M:\CENTRALSERVICES\CLERICAL\PUB-SV.WK\MASTER.PS\ENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />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 />(City, State, Zip Code) <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 />Signature of Applicant - Title Date <br />PACIFIC BELL TELEPHONE COMPANY DBA AT&T <br />CALIFORNIA/VCC PERMIT DESK <br />1445 VAN NESS AVE <br />Fresno, CA 93721 <br />559-552-4608 G26977@ATT.COM <br />1/30/2023 <br />$&23<2)7+(75$)),&&21752/3/$1,668%0,77(':,7+7+,63(50,7 <br />6(($77$&+0(176 <br />INTERSECTION OF SEXTON RD & GREENLEAF RD <br />ACCESS NEW SDG&E POLES #1, #2, #3, #5, #7, #11, #13, #17, #18 ALONG SEXTON RD & POLE #8, <br />#9, #10 TO TRANSFER FACILITIES FROM OLD ATT POLES. <br />0 <br />SEE ATTACHED LAYOUT & TCP DRAWINGS FOR AT&T JOB #A023750. <br />ATT FACILITES TO NEW SDG&E POLES. <br />Work will commence on or about ______________________________ for approximately ____5____________________ 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 />EngineeringAdministrator 01/30/2023