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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 7/25/23 <br />To: San Joaquin County <br />Department of Public Works <br />PACIFIC BELL TELEPHONE COMPANY DBA AT&T CALIFORN IANCC PERMIT 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 <br />(Area Code - Telephone Number) <br />g26977@att.com <br />(Email Address) <br />may <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />TCP: ACCESS 5 MH'S & 6 POLE'S TO PLACE CABLE <br />SEE ATTACHED TCP DRAWINGS FOR AT&T JOB# A02LJ50. <br />Estimated Start Date: 11-01-23 <br />Duration: 7 Days <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />MULTIPLE LOCATIONS ALONG HAMMOND ST & N JACK TONE RD approximately Q feet/ Qmile <br />of _ , by performing the following work (description of work): <br />TCP'. ACCESS 5 MIT A & 6 POLE'S TO PLACE CABLE <br />Work will commence on or after 11/1/23 for approximately 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 />Brian E. Schultz pie 20233 signed <br />13` 56 oe 0700 7/25/23 <br />Signature of Applicant - Title Engineering Date <br />Administrator <br />