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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/29/23 <br />To: San Joaquin County <br />Department of Public Works <br />PACIFIC BELL TELEPHONE COMPANY DBA AT&T CALIFORN IANCC 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 <br />(Area Code - Telephone Number) <br />g26977@att.com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730079 REF # <br />CR # <br />TO DRIVEWAYS: <br />orr�W Rd. <br />Iracy QUAD <br />Traffic Control Devices <br />Special Conditions <br />SIGNAGE PLACED IN COUNTY OF SAN JOAQUIN R.O.W. TO PLACE & SPLICE CABLE CITY <br />OF TRACY R.O.W. <br />SEE ATTACHED TCP DRAWINGS FOR AT&T JOB# A02BDV9. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the 4600 CORRAL HOLLOW RD —approximately Q feet/ Qmile <br />of , by performing the following work (description of work): <br />SIGNAGE PLACED IN COUNTY OF SAN JOAQUIN R.O.W. TO PLACE & SPLICE CABLE CITY OF TRACY R.O.W. <br />Work will commence on or after for approximately 9 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 />Brian E. Schultz p230647S00ie203291424-OP06/29/23 <br />Signature of Applicant - Title Engineering Date <br />Administrator <br />