Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/2/2023 <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 Highway Right -of -Way on <br />the EAST side of ELLIOTT RD approximately 44 ee mile SOUTH <br />of ELLIOTT RD , by performing the following work (-description of work): <br />ACCESS EXISTING POLE#25488 TO SPLICE EXISTING AERIAL CABLE. <br />S/S LIBERTY RD, 655' W/O ELLIOTT RD, ACCESS (5) EXISTING POLES TO SPLICE & PLACE NEW <br />AERIAL CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02N1J5. <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 />s P �Z - Engineering Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />10-2-2023 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />TO 11/1/2023 DRIVEWAYS: <br />STREET <br />Elliott Rd, & Liberty Rd. <br />AREA <br />Campo QUAD NE <br />TYPE <br />Aerial Work <br />FORMS <br />SSAA/VV <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 Highway Right -of -Way on <br />the EAST side of ELLIOTT RD approximately 44 ee mile SOUTH <br />of ELLIOTT RD , by performing the following work (-description of work): <br />ACCESS EXISTING POLE#25488 TO SPLICE EXISTING AERIAL CABLE. <br />S/S LIBERTY RD, 655' W/O ELLIOTT RD, ACCESS (5) EXISTING POLES TO SPLICE & PLACE NEW <br />AERIAL CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02N1J5. <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 />s P �Z - Engineering Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />10-2-2023 <br />Date <br />