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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/31/24 <br />To: San Joaquin County <br />Department of Public Works <br />PACIFIC BELL TELEPHONE COMPANY DBA AT&T CALIFORN IANCC 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 />SEE ATTACHED LAYOUT & TCP DRAWINGS FOR AT&T JOB# A02MXWA. <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 LINCOLN WAY approximately 1489 QQ feet/Qmile SAN <br />of c/L OF Kosr RD 27251 N HOPSACRAMENTO RD , by performing the following work (description of work): <br />PLACE 27' OF 1-4" DUCTS VIA TRENCH; PLACE 26' OF 3-4" DUCTS VIA TRENCH; PLACE 23' OF 6-4" DUCTS VIA TRENCH; DIG (7) 4'X4' PITS; <br />PLACE 3394' OF 3-4" DUCTS VIA BORE; DIG (2) 4'1 DIG (1) 5'1 & PLACE 4x4x4 MH; DIG 1 VXT PIT & PLACE NEW PTS 65 MH. <br />Work will commence on or after 2/14/24 for approximately 21 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 p2013by 9r�74000ie204104481/31/24 <br />Signature of Applicant - Title Engineering Date <br />Administrator <br />