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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 09/15/2023 <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)285-4894 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 Hig <br />the NORTH side of VIA NICOLO RD approximately 2640 <br />of W PATTERSON PASS RD I , by performing the following work <br />ACCESS EXISTING POLE TO SPLICE EXISTING AERIAL CABLE. S/S S SCHULI <br />Right -of -Way on <br />nile N/E <br />ription of work): <br />D. 212' W/O <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT FOR AT&T JOB# A021\1864. <br />Work will commence on or about 10/09/2023- 01/09/2024 for approximately 2 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 <br />8r2,-wE-7 Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />09/18/2023 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID101912023 <br />TO DRIVEWAYS: <br />STREET <br />—V -517c -7577d. <br />AREA <br />racy QUAD SW <br />TYPE <br />ra i�frol Devices <br />FORMS <br />NOTES <br />Special Conditions <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 Hig <br />the NORTH side of VIA NICOLO RD approximately 2640 <br />of W PATTERSON PASS RD I , by performing the following work <br />ACCESS EXISTING POLE TO SPLICE EXISTING AERIAL CABLE. S/S S SCHULI <br />Right -of -Way on <br />nile N/E <br />ription of work): <br />D. 212' W/O <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT FOR AT&T JOB# A021\1864. <br />Work will commence on or about 10/09/2023- 01/09/2024 for approximately 2 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 <br />8r2,-wE-7 Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />09/18/2023 <br />Date <br />