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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 05/04/2022 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T CALIFORNIA - VALLEY PERMIT 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 />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the WEST side of WEST LN (COUNTY RD -J3) approximately 84 ee mile SOUTH <br />of ARMSTRONG RD , by performing the following work (-description of work): <br />ACCESS MANHOLE#250 TO SPLICE EXISTING CABLE. <br />W/S MICKE GROVE RD, 398' N/O EIGHT MILE RD, ACCESS POLE#10979 TO PLACE & SPLICE NEW CABLE. <br />S/S ARMSTRONG RD, 51' W/O MICKE GROVE RD, ACCESS SPLICEBOX#800 TO SPLICE EXISTING CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02C5SB. <br />Work will commence on or about <br />for approximately <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 />5/4 LAaAA�f, ez �/ Engineering Administrator <br />Signatur of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />5-5-2022 <br />Date <br />OFFICE USE ONLY <br />730052 <br />JOB # <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />511912022 TO II si2IJ22 DRIVEWAYS: <br />STREET <br />Vifesl.t'1 <br />AREA <br />Lodi QUAD <br />TYPE <br />raTff7=oTol Devices <br />FORMS <br />SSMW <br />NOTES <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the WEST side of WEST LN (COUNTY RD -J3) approximately 84 ee mile SOUTH <br />of ARMSTRONG RD , by performing the following work (-description of work): <br />ACCESS MANHOLE#250 TO SPLICE EXISTING CABLE. <br />W/S MICKE GROVE RD, 398' N/O EIGHT MILE RD, ACCESS POLE#10979 TO PLACE & SPLICE NEW CABLE. <br />S/S ARMSTRONG RD, 51' W/O MICKE GROVE RD, ACCESS SPLICEBOX#800 TO SPLICE EXISTING CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02C5SB. <br />Work will commence on or about <br />for approximately <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 />5/4 LAaAA�f, ez �/ Engineering Administrator <br />Signatur of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />5-5-2022 <br />Date <br />