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APPLICA 11UN FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />1/0 1 /2020 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T/ VCC PERMIT DESK <br />(AppBioant Name) <br />5555 E. ®LIVE AVE <br />(Mailing Address) <br />FRESNO, CA 93727 <br />(City, State, Zip Code) <br />559) 454-4900 826977@att.com <br />(Area Code -Telephone <br />Number) <br />Sketch (Detailed plans may be submitted) <br />TCP to access AT&T MHs to Rod & Rope only. A01 MQ5N <br />Access the following: MH 1,141 (37 E. Hospital Rd), MH 408 (7400 S. EI Dorado St) <br />SB 939 (221 Manila Rd), SB 2688 (200 Frewert Rd), SB 2687 (39 KLO Rd), <br />SBS 435 (12565 S. Manthey Rd), SB 436 (12715 S. Manthey Rd) <br />Ronald Scarberry <br />(559) 4544110 <br />The undersigned hereby applies for permission to excavate, construct ar�d/or otherwise encroach on County Highway Right -of -Way on <br />the side of approximately feet/mile <br />of Various I acatibmr.;--listead ghWe by performing the following work (description of work): <br />Worl< will commence on or about �� �- for approximately � _ days. <br />I, the undersigned, certify that I am the owner of the respective property, or am <br />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 />� � � /�� Engineering <br />Signature of <br />Administrator <br />Title <br />E:1P117-SV.VJI�MASTER.P5IENCROACHIAEIJT PERhIIT APPLICATIOIJDOC (o170B) <br />01/31/2020 <br />Date <br />OFFICE USE ONLY <br />JOB# <br />REF# <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />AREA <br />QUAD <br />TYPE <br />FORMS <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />TCP to access AT&T MHs to Rod & Rope only. A01 MQ5N <br />Access the following: MH 1,141 (37 E. Hospital Rd), MH 408 (7400 S. EI Dorado St) <br />SB 939 (221 Manila Rd), SB 2688 (200 Frewert Rd), SB 2687 (39 KLO Rd), <br />SBS 435 (12565 S. Manthey Rd), SB 436 (12715 S. Manthey Rd) <br />Ronald Scarberry <br />(559) 4544110 <br />The undersigned hereby applies for permission to excavate, construct ar�d/or otherwise encroach on County Highway Right -of -Way on <br />the side of approximately feet/mile <br />of Various I acatibmr.;--listead ghWe by performing the following work (description of work): <br />Worl< will commence on or about �� �- for approximately � _ days. <br />I, the undersigned, certify that I am the owner of the respective property, or am <br />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 />� � � /�� Engineering <br />Signature of <br />Administrator <br />Title <br />E:1P117-SV.VJI�MASTER.P5IENCROACHIAEIJT PERhIIT APPLICATIOIJDOC (o170B) <br />01/31/2020 <br />Date <br />