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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/6/23 <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 />3/20/2023 TO 5/15/2023 DRIVEWAYS: <br />Corral Hollow Rd. <br />Tracy QUAD SW <br />Traffic Control Devices <br />SS/WW <br />Special Conditions <br />SEE ATTACHED TCP DRAWINGS FOR AT&T JOB# A02HHT7. <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 CORRALHOLLOWRD approximately 480 @ feet/Qmile SOUTH <br />of VALPICO RD TRACY , by performing the following work (description of work): <br />ACCESS MH 11941 &MH 27022 TO PLACE CABLE. <br />SEE ATTACHED TCP DRAWINGS FOR AT&T JOB #A02HHT7. <br />Work will commence on or after 3/20/23 for approximately 6 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 pie 202330306132715 0800 3/6/23 <br />Signature of Applicant - Title Engineering Date <br />Administrator <br />