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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/22/24 <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 />Sketch (Detailed plans may be submitted) <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 />3/4/2024 TO 6/4/2024 DRIVEWAYS: <br />Marsh St <br />Stockton QUAD <br />Trench <br />SSNW ,, R-29, Trench Cut Policy <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 SOUTH side of E MARSH ST. approximately 908 (j) feet/ O mile N/E <br />of BIRD AVE. , by performing the following work (description of work): <br />NEED TO TRENCH AND BORE FROM SUB BOX IN FRONT AND TO THE RIGHT OF ENTRY GATE TO THE REAR OF PROPERTY NEXT TO GAS METER AND ELECTRIC PANEL. <br />AT&T PROJECT JOB #21799616 <br />Work will commence on or after 3/4/24 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 />2/22/24 <br />Signature of Applicant - Title Date <br />