Laserfiche WebLink
PLEASE PRINT: <br />Date I ,, <br />To: San Joaquin County <br />Department of Public Works <br />ATT (SHERRY PARKS) <br />(Applicant Name) <br />5555 E OLIVE AVE <br />(Mailing Address) <br />FRESNO CA 93727 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />559-454-4900 EMAIL g26977@att.com <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />THIS JOB (ATT AOOX05P) REQUIRES SPLICING IN EXISTING MANHOLE 702 WHICH IS IN THE SHOULDER OF WEST BOUND <br />WOODBRIDGE RD AT FRONT OF 40 WOODBRIDGE RD N/0 LODI AND REQUIRES A COUNTY OF SAN JOAQUIN PERMIT FOR A TCP TO <br />ACCESS THIS MAN HOLE, DRAWINGS ARE ATTACHED, PLEASE CALL ATT ENGINEER DEBBIE SNEED (559-739-6646) WITH ANY <br />QUESTIONS. <br />The undersigned hereby applies for permission to <br />the side gf 7�/C��j/�' 1� <br />construct and/or otherwise encroa � County Highway Right -of -Way on <br />approximately r� feet/mile <br />of <br />by performing the following work (description of work): <br />Work will commence on or about — a, S � 1 tl for approximately days. <br />I, the undersigned, certify that I am the owner of the respective property <br />, 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 />- lit c�J <br />m i ►-, i 5�--r <br />�.'�"" Signa oo�Applicant - Titl ` <br />M:ICEIJTRALSERVICESICLERICALIPU&SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09113) <br />Date <br />OFFICE USE ONLY <br />JOB# <br />O1/7� REF# <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />^l - <br />- - I TO ' 7 DRIVEWAYS: <br />STREET <br />AREA <br />TYPE <br />�C�UA 41141 <br />FORMS <br />55 1W i ;c <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />THIS JOB (ATT AOOX05P) REQUIRES SPLICING IN EXISTING MANHOLE 702 WHICH IS IN THE SHOULDER OF WEST BOUND <br />WOODBRIDGE RD AT FRONT OF 40 WOODBRIDGE RD N/0 LODI AND REQUIRES A COUNTY OF SAN JOAQUIN PERMIT FOR A TCP TO <br />ACCESS THIS MAN HOLE, DRAWINGS ARE ATTACHED, PLEASE CALL ATT ENGINEER DEBBIE SNEED (559-739-6646) WITH ANY <br />QUESTIONS. <br />The undersigned hereby applies for permission to <br />the side gf 7�/C��j/�' 1� <br />construct and/or otherwise encroa � County Highway Right -of -Way on <br />approximately r� feet/mile <br />of <br />by performing the following work (description of work): <br />Work will commence on or about — a, S � 1 tl for approximately days. <br />I, the undersigned, certify that I am the owner of the respective property <br />, 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 />- lit c�J <br />m i ►-, i 5�--r <br />�.'�"" Signa oo�Applicant - Titl ` <br />M:ICEIJTRALSERVICESICLERICALIPU&SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09113) <br />Date <br />