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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/14/24 <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 />2128/24 TO 5/28/24 DRIVEWAYS: <br />Newton Rd. <br />Stockton 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 />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 NEWTON RD. approximately 1150 @ feet/ Qmile SOUTH <br />of E STEVENSON RD. _ , by performing the following work (description of work): <br />TCP NEEDED FOR SHOULDER CLOSURE TO PFOESS SB #2918 ON NEWTON RD JTCT PROJECT JOB #J02S3DD <br />ADDRESS: 3732 NEWTON RD., APN: 13207017 <br />Work will commence on or after 2/28/24 for approximately 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 />2/14/24 <br />Signature of Applicant - Title <br />Date <br />