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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/28/24 <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 />please see attached documents. <br />JOB NUMBER-A02838J <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 N BROADWAYAVE side of NORTH-WEST approximately 115 @ feet/ 0mile <br />of N WINDSOR AVE _ , by performing the following work (description of work): <br />LAYOUT REQUIRED TO REMOVE (E)SB#2702 (3'1 AND REPLACE IT WITH (4'X 4'X4') MANHOLE IN DIRT SURFACE. <br />TCP NEEDED FOR SHOULDER CLOSURE TO PLACE NEW MH #2702 ON N BROADWAY AVE. AT&T JOB #A02S38J <br />Work will commence on or after 4/8/24 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 />Brian E. Schultz p�23281657000ieID4001473/28/24 <br />Signature of Applicant - Title <br />Date <br />