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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/4/2023 <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 />SEE ATTACHED LAYOUT & TCP DRAWINGS FOR AT&T JOB# A02LZAN. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the MULTIPLE LOCATIONS ALONG ELLIOTT RD —approximately @ feet/ Qmile <br />of , by performing the following work (description of work): <br />DIG (2) TX11' PITS & PLACE (2) NEW PTS -65 MH'S; DIG (13) 4'X4' PITS; DIG (1) 4'X6' PIT <br />DIG (2) 5'X5' PITS & PLACE (2) NEW 4'X4'X4' INTERCEPT BOXES WITH LOCKING LIDS <br />PLACE 2880'2-4" DUCTS VIA BORE; PLACE 33'2-4" DUCTS VIA TRENCH; PLACE 1644" DUCTS VIA TRENCH <br />Work will commence on or after 12/01/2023 COMPLETE APPROX 2/1/2024_ for approximately 10 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 />c�iLaivt�y PQ�i�.d�b2 .A%�f /� Engineering Administrator <br />Signatur of Applicant -Title Engineering <br />Administrator <br />10-4-2023 <br />Date <br />