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I�PPLIGATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 01/29/2020 <br />To; San Joaquin County <br />Department of Public Works <br />AT&T / VCC PERMITS DESK <br />(Applicant Name) <br />A <br />5555 E. Olive Ave <br />(Mailing Address) <br />Fresno, CA 93727 <br />(City, State, Zip Code) <br />(559) 454-4900 g26977@att.coir <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB # I 0 60 S REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />REA QUAD <br />TYPE <br />FORMS <br />NOTES <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />1. Front of 4-583 Rcampo Cid, /�campo, C�a <br />The untlersianed hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH side of ACAMPO RD approximately 62 ee mile EAST <br />of N 99 FRONTAGE RD f , by performing the following work scription of work); <br />ACCESS POLE TO SLICE EXISTING AERIAL FIBER CABLE, W/S N 99 FRONTAGE RD, 62' <br />N/0 ACAPMP RD, ACCESS; SPLICEBOX# 807- TO SPLICE EXISTING FIBER CABLE, THE <br />ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# AOIRXX2. <br />Work will commence on or about 03/04/2020 to 06/04/2020 for approximately 2 days days. <br />I, the undersigned, certify that I am the owner of the respective propert <br />y, 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 />tngmeermg <br />Administrator <br />01 /30/2020 <br />Signature of Applica�`Title Date <br />FA:ICENTRALSERVICESICLERICALIPUB-SV.WK7v1ASTER.PSIENCROAChIMENT PERMIT P.PPLICATION.GOC (09117) <br />