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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/19/24 <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 />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 />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 WSCHULTE RD. approximately 1035 @ feet/ Qmile WEST <br />of S SCHULTE CT. _ , by performing the following work (description of work): <br />TCP NEEDED FOR SHOULDER CLOSURETO ACCESS AHR623 & SB Wes ON s SCHULTE RD. &w SCHULTE RD. <br />AT&T JOB #A02SW51. <br />25465 S SCHULTE RD. & 17eeo w SCHULTE RD. <br />Work will commence on or after 8/21/24 for approximately 2 days. <br />Approx Start Date 3/21/24 Approx End Date: 4/19/24 <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 zo3�9024000piemi110573/19/24 <br />Signature of Applicant - Title <br />Date <br />