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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/21/24 <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 />4/10/24 TO 7/10/24 DRIVEWAYS: <br />Stockton St. <br />Thornton QUAD <br />Trench <br />SS/WW, R-29 <br />Special Conditions <br />Sketch (Detailed plans may be submitted) A02S823 <br />PLANS ATTACHED <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 W STOCKTON ST. approximately 99 Q feet/ © mile EAST <br />of MORI RD. , by performing the following work (description of work): <br />TRENCH 10'X 2.5'D(25 SO FT) IN DIRT SURFACE.PLACE GROUND BED WITH (2)-8' GROUNDRODS AND #6 GROUND WIRE ON (E)POLE LOC 2(P.08418). <br />TCP REQUIRED FOR SHOULDER CLOSURE FOR GROUND BED PLACEMENT ON W STOCKTON ST., AT&T JOB #A02S823 <br />8402 W STOCKTON ST. <br />Work will commence on or after 4/10/24 for approximately 4 days. <br />Est Start: 4/10/24 Est Comp: 7/10/24 Duration: 4 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 />3/21124 <br />Signature of Applicant - Title Date <br />