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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/14/2022 <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 />FOR AT&T JOB# A028Z9W <br />A028Z9W <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroac County Highway Right -of -Way on <br />the SOUTH side of W SWAIN RD approximately ee mileSOUTH WEST <br />of HARRISBURG PL Ibyperformingthefollowingwork( scriptionofwork): <br />1900 W SWAIN RD: ACCESS MANHOLE #1851 AND MANHOLE #1850 TO PLACE AND SPLICE <br />NEW FIBER CABLE. THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR <br />FOR AT&T JOB# A028Z9W. <br />Work will commence on or about <br />for approximately <br />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 />Administrator <br />Signature of Applicant - tWe <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />[0i►1!I[!f►"1iM <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />7/15/2022 TO <br />11/1/2022 DRIVEWAYS: <br />STREET <br />Swain Rd. <br />AREA <br />Stockton QUAD <br />LV <br />TYPE <br />Traffic Control Devices <br />FORMS <br />SS/WW <br />NOTES <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT <br />FOR AT&T JOB# A028Z9W <br />A028Z9W <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroac County Highway Right -of -Way on <br />the SOUTH side of W SWAIN RD approximately ee mileSOUTH WEST <br />of HARRISBURG PL Ibyperformingthefollowingwork( scriptionofwork): <br />1900 W SWAIN RD: ACCESS MANHOLE #1851 AND MANHOLE #1850 TO PLACE AND SPLICE <br />NEW FIBER CABLE. THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR <br />FOR AT&T JOB# A028Z9W. <br />Work will commence on or about <br />for approximately <br />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 />Administrator <br />Signature of Applicant - tWe <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />[0i►1!I[!f►"1iM <br />Date <br />