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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 04/17/2023 <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 />A020KFW4 <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 S VAN ALLEN RD approximately 131ee mileNORTH <br />of YOSEMITE AVE (CA -120) I , by performing the following work ( scription of work): <br />ACCESS EXISTING BARREL VAULT#17967 TO SPLICE & PLACE NEW CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02KFW4. <br />ESTIMATED START: 4/28/23 ESTIMATED COMPLETE: 7/28/23 DURATION: 3 DAYS <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 App' ant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />04/17/2023 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />Val I A ell d. <br />AREA <br />sca on QUAD bE <br />TYPE <br />—Traffl7inDrtrotroevices <br />FORMS <br />SS/WW <br />NOTES <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />A020KFW4 <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 S VAN ALLEN RD approximately 131ee mileNORTH <br />of YOSEMITE AVE (CA -120) I , by performing the following work ( scription of work): <br />ACCESS EXISTING BARREL VAULT#17967 TO SPLICE & PLACE NEW CABLE. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02KFW4. <br />ESTIMATED START: 4/28/23 ESTIMATED COMPLETE: 7/28/23 DURATION: 3 DAYS <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 App' ant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />04/17/2023 <br />Date <br />