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APPLICATION FOR ENCROACHIVENT PERMT <br />PLEASE PRINT: <br />Date 1/2/2020 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T/DBA PACIFIC BELL <br />(Applicant Name) <br />5555 E OLIVE AVE RM 450C <br />(A/biling Address) <br />FRESNO, CA 93727 <br />(City, State, Zip Cotle) <br />559-454-3831 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Please see attached TCP. AT&T project number A01 PYRX. <br />,4e, txAl a �s w '�� L' G ►�1 ��c �• / !/ ire a e4 641y. <br />Michael Mccarley <br />(209) 474=4774 <br />The undersianed hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Wav on <br />the south side of Roth Rd approximately 160 feet/�+le East <br />of _ S Mckinlev Ave I , by performing the following work (description of work): <br />Place aerial cable on existing pole lead from S Mckinley Ave to A St on Roth Rd. <br />Work will commence on or about 1/13/2020 <br />for approximately _ 4 days <br />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 />Signature of <br />'Title <br />Engineering <br />Administrator <br />M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCRCACHMENT PERMIT APPLICATION.BCC (89/13) <br />01/02/2020 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />" j 0,47 l� REF # <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />STREET <br />AREAgoo/ <br />f0 2 iS Z DRIVEWAYS: <br />G,(/�� -46Z6 We <br />WOO QUAD Std <br />TYPE�,/►,�gdOV*eG <br />e! 9 ri24V 7*6/tet <br />FORMS <br />NOTES <br />g*ze6t / <br />f"' 0ge'#41, / <br />Sketch (Detailed plans may be submitted) <br />Please see attached TCP. AT&T project number A01 PYRX. <br />,4e, txAl a �s w '�� L' G ►�1 ��c �• / !/ ire a e4 641y. <br />Michael Mccarley <br />(209) 474=4774 <br />The undersianed hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Wav on <br />the south side of Roth Rd approximately 160 feet/�+le East <br />of _ S Mckinlev Ave I , by performing the following work (description of work): <br />Place aerial cable on existing pole lead from S Mckinley Ave to A St on Roth Rd. <br />Work will commence on or about 1/13/2020 <br />for approximately _ 4 days <br />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 />Signature of <br />'Title <br />Engineering <br />Administrator <br />M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCRCACHMENT PERMIT APPLICATION.BCC (89/13) <br />01/02/2020 <br />Date <br />