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APPLICATION FOR ENCROACHMENT PERMIT PLEASE PRINT: Date 11 /15/19 To: San Joaquin County Department of Public Works AT&T/ VCC PERMITS DESK (Applicant Name) 5555 E. Olive Ave (Mailing Address) Fresno, CA 93727 (City, State, Zip Code) (559) 454-4900 g26977@att.co (Area Code -Telephone Number) Sketch (Detailed plans may be submitted) JOB# APN EXP.DATE VALID STREET AREA TYPE FORMS NOTES IT TRAFFIC CONTROL TO ACCESS STRUCTURE. OFFICE USE ONLY REF# CR# TO QUAD A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; SEE ATTACHMENTS. Est Start: 12/09/2019 Est Comp 01/03/2020 DRIVEWAYS: . . • The undersioned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on the SOUTH side of WATERLOO RD approximately 105 ee mile NORTHEAST of N FILBERT ST , _______ , by performing the following work scription of work): ACCESS MANHOLE# 325 (STREET) TO PLACE & SPLICE NEW FIBER CABLE. E/S WATERLOO RD. 205' N/E N NEWPORT AVE, ACCESS MANHOLE# 326 TO PLACE & SPLICE NEW FIBER CABLE. THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A01PATY. Work will commence on or about _ __;_:12"'""/9'-'---/1-'----'9 __________ for approximately __ -'-4 ______ days. 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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. L?. <;;~ Engineering /' /r.L ~(-Administrator / //) /;l.()/7 SignatureofApplicae l 'bate M:\CENTRALSERVICESICLERICALIPUB-SV.WK\MASTER.PSIEMCROACHMENT PERMIT APPLICATION.DOC (09/13)