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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 06/19/2023 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T CALIFORNIA/ VALLEY 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 G26977@ATT.COM <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <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 WEST side of W 11 TH ST approximately 180 ee mileNORTHEAST <br />of LOVELY RD I , by performing the following work (-description of work): <br />DIG 4'X4' BORE PIT LOCATE & INTERCEPT EXIST. DUCT & PLACE NEW WYE CAST. BORE & <br />PLACE 12'1-4" DUCT IN DIRT. <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT. SEE THE ATTACHED PERMIT DRAWINGS <br />FOR AT&T JOB# A02M46H. <br />Work will commence on or about 7/17/2023 for approximately 3 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 />Engineering Administrator <br />Signatur of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />6-30-2023 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />9/17/2023 <br />TO 12/15/2023 DRIVEWAYS: <br />STREET <br />Eleventh St. <br />AREA <br />Tracy <br />QUAD SW <br />TYPE <br />Bore Pit, Bore <br />FORMS <br />SSAAAA1 R -9g <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 WEST side of W 11 TH ST approximately 180 ee mileNORTHEAST <br />of LOVELY RD I , by performing the following work (-description of work): <br />DIG 4'X4' BORE PIT LOCATE & INTERCEPT EXIST. DUCT & PLACE NEW WYE CAST. BORE & <br />PLACE 12'1-4" DUCT IN DIRT. <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT. SEE THE ATTACHED PERMIT DRAWINGS <br />FOR AT&T JOB# A02M46H. <br />Work will commence on or about 7/17/2023 for approximately 3 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 />Engineering Administrator <br />Signatur of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />6-30-2023 <br />Date <br />