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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/30/24 <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 />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 />THIS PERMIT IS FOR A COPPER RECLAMATION PROJECT SO THAT WE CAN REMOVE <br />UNUSED COPPER CABLE FROM OUR UNDERGROUND AND/OR AERIAL FEEDS. THERE IS <br />NO EXCAVATION REQUIRED. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the side of approximately 0feet/ Qmile <br />of _ by performing the following work (description of work): <br />TCP REQUIRED FOR RIGHT LANE CLOSURE ON N PERSHING AVE. &N ELDORADO ST., SHOULDER CLOSURE N RYDE AVE.,VVEST LN. & E MAIN ST. <br />AND LANE SHIFT ON E COUNTY CLUB BLVD., & WATERLOO RD. TO ACCESS (5) MH & (2) SB. AT&T A02QYKF <br />Work will commence on or after 2/12/24 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 />1/30/24 <br />Signature of Applicant - Mle <br />Date <br />