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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/26/24 <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) 2854894 <br />(Area Code - Telephone Number) <br />g26977@aft.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <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 />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 W BENJAMIN HOLT DR. approximately 175 � feet/ 0 mile sm <br />of ALEXANDRIA PL. 1 , by performing the following work (description of work): <br />TCP NEEDED FOR SHOULDER CLOSURE TO ACCESS MH #804,POLE #2208 ,POLE #02180 & PFP ON ALEXANDRIA PL. & W BENJAMIN HOLT DR. <br />AT&T JOB #A02RNAC <br />Work will commence on or after 4/1/24 for approximately 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 />Bre E sCy"&S Engineering Administrator <br />Signature of Applicant - Title <br />3/26/24 <br />Date <br />