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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/28/23 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T/ VCC 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 <br />(Area Code - Telephone Number) <br />826977@att.com <br />(Email Address) <br />may <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <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 SOUTH side of W LANTHROP RD approximately 3500 @ feet/ Qmile <br />of N MAIN ST _ , by performing the following work (description of work): <br />SIGNAGE ONLY FOR ACCESS FOR (17) EXT. POLES LOCATED ON ABC OF W IATHROP RD FOR SPLICE PLACEMENT NEW FIBER CABLE (POLES IN CITY OF MANTECA) <br />- SIGNAGE ONLY FOR ACCESS FOR (7) EXT. POLES LOCATED ON EO OF N MAIN ST FOR SPLICEPIACEMENT NEW FIBER CABLE (POLES INCITY OF MANTECA) <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT FOR AT&T JOB#A02F503 <br />Work will commence on or after 3/15/23 for approximately 5 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 />3/2/23 <br />Signature of Applicant - Ale <br />Date <br />