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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/9/24 <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 />(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 />2123/24 TO 5/23/24 DRIVEWAYS: <br />oro Ave. <br />Stockton QUAD <br />Aerial Work <br />SS/vwv <br />Special Conditions <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; SEE <br />ATTACHMENTS <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the EAST side of S ORO AVE. approximately 150 @ feet/ 0MIle N/E <br />of HORNER AVE. _ , by performing the following work (description of work): <br />TCP NEEDED FOR SHOULDER CLOSURE TO ACCESS PFP #714 & POLE #616 ON S ORO AVE. <br />AT&T JOB A02RMQA. <br />Work will commence on or after 2123/24 for approximately 6 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 />2/9/24 <br />Signature of Applicant - Title <br />Date <br />