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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/24/2022 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T CALIFORNIA -VALLEY PERMITS DESK <br />(Applicant Name) <br />1445 VAN NESS AVE <br />(Mailing Address) <br />FRESNO, CA 93721 <br />(City, State, Zip Code) <br />(559) 552-4608 g26977@att.com <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT <br />FOR AT&T JOB# A028318 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH EAST side of SANGUINETTI LN approximately 370 ee mile NORTHWEST <br />of N WILSON WAY , by performing the following work (-description of work): <br />Work will commence on or about 6/30/2022 for approximately 7 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 />8� ( S- Engineering <br />administrator <br />Signature of Applic ht - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />02/24/2022 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />bJJUJZUZZ <br />TO DRIVEWAYS: <br />STREET <br />an�guineftI <br />In. <br />AREA <br />Stockton <br />QUAD NS <br />TYPE <br />AeII8IVV01k7z` <br />Traffic CnT7rU 0777= <br />FORMS <br />NOTES <br />Special conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT <br />FOR AT&T JOB# A028318 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH EAST side of SANGUINETTI LN approximately 370 ee mile NORTHWEST <br />of N WILSON WAY , by performing the following work (-description of work): <br />Work will commence on or about 6/30/2022 for approximately 7 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 />8� ( S- Engineering <br />administrator <br />Signature of Applic ht - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />02/24/2022 <br />Date <br />