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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1 /24/2020 <br />To: San Joaquin County <br />Department of Public Works <br />VCC PERMITS DESK, AT&T <br />(Applicant Name) <br />5555 E OLIVE AVE <br />(Mailing Address) <br />FRESNO, CA 93727 <br />(City, State, Zip Code) <br />(559) 454-490.0 <br />(Area Code -Telephone Numher) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET _ <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />THIS JOB PROPOSES THE FOLLOWING WORK IN SAN JOAQUIN COUNTY RIGHT OF WAY: <br />TRENCH 18' IN DIRT TO INSTALL GROUND BEDS CONSISTING OF (3)-8' GROUND RODS AND #6 GROUND WIRE AT AT&T POLES P.8, P.13, AND P.18. <br />TRAFFIC CONTROL PLAN FOR THE ABOVE MENTIONED WORK IN CONJUNCTION WITH APPROXIMATELY 4120' OF NEW AERIAL CABLE PLACEMENT BETWEE14 AT&T POLES <br />PA AND P.18, AND THEN UNDERGROUND TO P.19. <br />SEE ATTACHED PERMIT AND TRAFFIC CONTROL PLAN DRAWINGS FOR AT&T JOB A01 RA4 D. <br />ESTIMATED CONSTRUCTION START 02/27/2020 A <br />ESTIMATED CONSTRUCTION COMPLETION 05/27/2020 A01(Z�yD <br />DURATION 7 DAYS <br />LOCATED NEAR 6095 E PELTIER ROAD , ACAMPO, CA <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of�Way on <br />the EAST SIDE side of N KEIJNEFICK RD approximately AT feet�mile <br />of E PELTIER RD by performing the following work (description of work): <br />INSTALL GROUND BEDS AT POLES P.B, P.13, AND P.18. <br />Work will commence on or about, 02/27/?_020 ^,for approximately _�� � days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to <br />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 />.Engineering <br />Administrator <br />Signature of Appl' nt -Title <br />M:10ENfRALSERI9CESICLEAICALIPUDSV.Wfi'MSTER.PS\ENCROACHAtENTPERh11T APPLICk710N.DOC (113) <br />01/24/2020 <br />pate <br />