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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/13/23 <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 <br />(Area Code - Telephone Number) <br />g26977@att.com <br />(Email Address) <br />may <br />SEE ATTACHED <br />Job# A02LJX2 <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 />9/21/2023 TO 11/21/2023 DRIVEWAYS: <br />Grigsby PI. <br />Stockton QUAD LV <br />Replace Down -Guy & Trench <br />SSfVi R-29 <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the EAST side of GRIGSBY PL approximately 205 @feet/Qmile SOUTH <br />of W BENJAMIN HOLT DR , by performing the following work (description of work): <br />REPLACE 1-10M DOM GUY 18EAST <br />PLACE 1—a ROD GROUND BED EAST OF NEW POLE <br />PLACE 1 METAT U GUARD wr PLASTIC <br />PG&E REMOVED OLD POLE <br />Work will commence on or after 9/21/23 for approximately 2 DAYS 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 pX➢09by 84ET00ie20130Brian <br />9/13/23 <br />Signature of Applicant - Title <br />Date <br />