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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 06/23/2023 <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 />A02MAM6 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the SOUTH side of W 11 TH ST approximately 145 ee mile EAST <br />of S CHRISMAN RD , by performing the following work (-description of work): <br />ACCESS EXISTING MANHOLE #168 (STREET) TO SPLICE EXIST CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02MAM6 <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 />18Ka4g/E. S c4uatk Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />06/26/2023 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />9/25/2023 TO 12/25/2023 DRIVEWAYS: <br />STREET <br />Eleventh St. <br />AREA <br />Tracy QUAD SW <br />TYPE <br />Traffic Control Devices <br />FORMS <br />SSAA/VV <br />NOTES <br />Spec ICondtons <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />A02MAM6 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the SOUTH side of W 11 TH ST approximately 145 ee mile EAST <br />of S CHRISMAN RD , by performing the following work (-description of work): <br />ACCESS EXISTING MANHOLE #168 (STREET) TO SPLICE EXIST CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02MAM6 <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 />18Ka4g/E. S c4uatk Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />06/26/2023 <br />Date <br />