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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 05/22/2023 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T CALIFORNIA / VALLEY PERMITS DES <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 />JOB # <br />730079 <br />REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />7/6/2023 TO <br />10/6/2023 DRIVEWAYS: <br />STREET <br />Mathawc Rd <br />AREA <br />Stockton QUAD <br />WS <br />TYPE <br />Traffic Control & Aerial Work <br />FORMS <br />SS/VVW <br />NOTES <br />Rnarial C;nnrlifinnc <br />permit is <br />sews Rd. <br />on <br />ivery Dr. & Swanson Rd. are private <br />ds maintained by the County Hospital. <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the NORTH side of W•MATHEWS RD approximately 15 ee mile WEST <br />of S DELIVERY DR , by performing the following work ( scription of work): <br />ACCESS (3) EXISTING POLES TO SPLICE & PLACE NEWAERIAL CABLE. <br />W/S S DELIVERY DR, 40' N/O W MATH EWS RD, ACCESS SPLICEBOX#1 TO PULL CABLE THRU. <br />W/S S DELIVERY DR, 182'S/0 SWANSON RD, ACCESS SPLICEBOX#2 TO PULL CABLE THRU. <br />ESTIMATED START: 07/06/23 ESTIMATED COMPLETE: 10/06/23 DURATION: 3 DAYS <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT FOR AT&T JOB# A021I <br />Work will commence on or about 07/06/2023 for approximately 3 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 />5����2 Engineering Administrator <br />Signature of Applicant - Title <br />MICENTP LSHNICE61CLHllCALIPUBSVWKIW STERP6IENCROACHNENT PERMIT APPLICATION 00C (0113) <br />6-21-2023 <br />Date <br />