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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/15/24 <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 />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 />2/27/24 TO 4/15/24 DRIVEWAYS: <br />North Cherokee Ln. <br />Acampo QUAD <br />Traffic Control Devices <br />SS/WW <br />Special Conditions <br />Sketch (Detailed plans may be submitted) <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS <br />A02 RM LY <br />Est Start: 02/27/24 Est Comp: 04/11/24 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the WEST side of N CHEROKEE LN. approximately 100 (j) feet/ Q mile NORTH <br />of COLLIER RD. E , by performing the following work (description of work): <br />TCP NEEDED FOR ONE LANE FLAGGER TO ACCESS FAP ON N CHEROKEE LN.. <br />AT&T JOB #A02RMLY <br />Work will commence on or after 2/27/24 for approximately 2 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 />Brian E. Schultz Digi�a2024.n2.15071810- 8'00' 2/15/24 <br />Dale: 2024.02.15 07:18:10 -08'00' <br />Signature of Applicant - Title Date <br />