Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 09/07/23 <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 />CA 93721 <br />(City, State, Zip Code) <br />(559)285-4894 <br />(Area Code - Telephone Number) <br />a26977@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 />9/21/2023 TO 11/21/2023 DRIVEWAYS: <br />Brennan Ave. <br />Escalon QUAD SE <br />Traffic Control Devices <br />SSM W <br />S ecial Conditions <br />ACTUALL WORK LOCATION IS WITHIN THE CITY OF ESCALON. THIS <br />PERMIT IS FOR THE TRAFFIC CONTROL DEVICES ON BRENNAN AVE. <br />SOUTH OF HWY 120 (YOSEMITE AVE.) <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 BRENNAN RD. approximately 200 FEET feet/mile NORTH <br />of YOSEMITE AVE. , by performing the following work (description of work): <br />AT&T JOB# A02DE7N REQUIRES FLAGGERS ALONG BRENNAN RD. TO ACCESS (1) POLE TO REMOVE OLD POLE, <br />PLACE GROUND BED, & TRANSFER FACILITIES. PLEASE SEE PERMIT TCP DRAWINGS FOR EXACT DETAILS. <br />Work will commence on or after 9/21/23 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 />z3n w £ ,S'c4hu&k� Administrator <br />Signature of Applicant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />9/8/23 <br />Date <br />