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PLEASEPRINTjAPPLICATIONFORENCROACHMENTPERMITDate1/15/2019To:SanJoaquinCountyDepartmentofPublicWorksOFFICEUSEONLYJOB#________APNEXP.DATEREF#CR#Fresno,CA93727(City,State,ZipCode)(559)454—4900g26977@att.corq(AreaCode-TelephoneNumber)VALIDSTREETAREATYPEFORMSNOTESDRIVEWAYS:yHgRight-of-WayonTheundersionedherebyappliesforpermissiontoexcavate,constructand/orotherwiseEASTtheNORTHsideofEMARIPOSARDapproximately__140_______ofSTAGECOACHRD•,___________________,byperformingthefollowingwork’ecriptionofwork):AERIALPLACEMENTOFMULTIPLEPOLESWITHAERIALSTREETCROSSING&BARRELVAULTACCESS.SEEATTACHEDDOCUMENTFORSPECIFICJOBLOCATION&DESCRIPTION.Workwillcommenceonorabout01/18/2019forapproximately120days.I,theundersigned,certifythatIamtheowneroftherespectiveproperty,oramqualified torepresenttheownerandagreetodotheworkdescribedaboveinaccordancewiththerulesandregulationsofSanJoaquinCountyandsubjecttoinspectionandapproval.AdministratorSignature01/15/2019DateAT&T/VCCPERMITSDESK(ApplicantName)5555E.OliveAve(MailingAddress)TOQUADSketch(Detailedplansmaybesubmitted)ACOPYOFTHETRAFFICCONTROLPLANISSUBMITTEDWITHTHISPERMIT;SEEATTACHMENTS(09/13)