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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/15/2023 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T CALIFORNIA - VALLEY PERMIT DESK <br />(Applicant Name) <br />1445 VAN NESS AVE <br />(Mailing Address) <br />FRESNO, CA 93721 <br />(City, State, Zip Code) <br />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 />A02R10P <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH sideof BRANDTRD. approximately 920 ee mile EAST <br />of N TAYLOR RANCH RD. , by performing the following work (-description of work): <br />TCP NEEDED FOR ONE LANE FLAGGER ON BRANDT RD. TO ACCESS POLE #12174 <br />FOR MORE DETAILS PLEASE REFER JOB# A02R10P <br />WORK ADDRESS: 12101 BRANDT RD. <br />Work will commence on or about 1/2/2024 EST COMP DATE: 4/2/2024 for approximately 1 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 />�f a411SC j7 Gf Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12/18/2023 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730079 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />1/2/2024 TO 4n si20?4 DRIVEWAYS: <br />STREET <br />RrandtRd <br />AREA <br />T,od; QUAD NTF <br />TYPE <br />Tr2ff;, ronr,-tet <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 />A02R10P <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH sideof BRANDTRD. approximately 920 ee mile EAST <br />of N TAYLOR RANCH RD. , by performing the following work (-description of work): <br />TCP NEEDED FOR ONE LANE FLAGGER ON BRANDT RD. TO ACCESS POLE #12174 <br />FOR MORE DETAILS PLEASE REFER JOB# A02R10P <br />WORK ADDRESS: 12101 BRANDT RD. <br />Work will commence on or about 1/2/2024 EST COMP DATE: 4/2/2024 for approximately 1 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 />�f a411SC j7 Gf Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />12/18/2023 <br />Date <br />