Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2023_PS-2301001 thru PS-2301500_ - PS-2301331

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APPLICATION FOR ENCROACHMENT PERMIT PLEASE PRINT: Date 5/17/2023 To: San Joaquin County Department of Public Works AT&T CALIFORNIA -VALLEY PERMITS DESK (Applicant Name) 1445 VAN NESS AVE (Mailing Address) FRESNO, CA 93721 (City, State, Zip Code) (559) 552-4608 g26977@att.com (Area Code - Telephone Number) Sketch (Detailed plans may be submitted) A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02FVY8 The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the SOUTH side of TEEPEE DR approximately 163 eel mile WEST of LANCE DR by performing the following work scription of work): 2895 TEEPEE DR (SEE ATTACHED DOCUMENT FOR MORE WORK LOCATIONS FOR AT&T JOB# A02FVY8)- ACCESS SPLICEBOXES #1637, #1635, #1616, #1625, #1628, #1615, #1621, #1623, #1627, #1626 AND MANHOLE #1631 TO PLACE AND SPLICE NEW FIBER CABLE. Work will commence on or about 6-1-2023 for approximately 7 days. 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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. Engineering Administrator Signature of Applicant - Title M: ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09/13) 5-17-2023 Date OFFICE USE ONLY JOB # 730079 REF # APN CR # EXP. DATE VALID 6/1/2023 TO 10/1/2023 DRIVEWAYS: STREET Teepee Dr. AREA Stockton QUAD NS TYPE Traffic Control Devices FORMS SS/WW NOTES Special Conditions A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02FVY8 The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the SOUTH side of TEEPEE DR approximately 163 eel mile WEST of LANCE DR by performing the following work scription of work): 2895 TEEPEE DR (SEE ATTACHED DOCUMENT FOR MORE WORK LOCATIONS FOR AT&T JOB# A02FVY8)- ACCESS SPLICEBOXES #1637, #1635, #1616, #1625, #1628, #1615, #1621, #1623, #1627, #1626 AND MANHOLE #1631 TO PLACE AND SPLICE NEW FIBER CABLE. Work will commence on or about 6-1-2023 for approximately 7 days. 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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. Engineering Administrator Signature of Applicant - Title M: ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09/13) 5-17-2023 Date