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PLEASE PRINT: <br />Date 1/11/24 <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 />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(559) 285-4894 <br />(Area Code - Telephone Number) <br />g26977@att.com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730079 REF # <br />CR # <br />1/25/24 TO 3/25/24 DRIVEWAYS: <br />Scottsdale Rd. <br />Lodi QUAD <br />Traffic Control Devices <br />SS/VVVV <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />ESTIMATED START: 01/25/2024 ESTIMATED COMPLETE: 03/25/24 DURATIONA DAY <br />A02 RABY <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 SCOTTSDALE RD. approximately 1750 @ feet/ Qmile WEST <br />of 99 FRONTAGE RD. _ , by performing the following work (description of work): <br />TCP NEEDED FOR ONE LANE CLOSURE WITH FLAGGER FOR POLE #3970 ACCESS ON SCOTTSDALE RD. ADDRESS : 3966 SCOTTSDALE RD. <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A02RA8Y. <br />Work will commence on or after 1/25/24 for approximately 1 TOTAL 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 />Signature of Applicant - Title <br />01/11/24 <br />Date <br />