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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/4/24 <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 />Sketch (Detailed plans may be submitted) <br />DWG ATTACHED <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS SS/WW, <br />NOTES <br />OFFICE USE ONLY <br />730079 <br />REF # <br />CR # <br />TO 711712024 DRIVEWAYS: <br />Tracy Blvd <br />QUAD <br />Trench (dirt shoulder) <br />R-29 <br />Special on I Ions <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 S TRACY BLVD. approximately 2490 Q feet/ Q mile <br />of WILLIAM ELTON "BROWNIE" BROWN FWY (1-580) , by performing the following work (description of work): <br />LAYOUT REOUI RED TO INSTALL +I-14' OF 11" CPC FROM POLE#31661 TO NEW SB#31619.PLACE NEW SB #31619 (30'X48") IN DIRT SURFACE.TCP NEEDED FOR SHOULDER CLOSURE TO PLACE NEW BE, TRENCHING & POLE ACCESS ON S TRACY BLVD. AT&T JOB A02HSLP. <br />Work will commence on or after 4/17/24 <br />for approximately <br />5 <br />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 Digila2024.n4.04091842- 7'00' 4/4/24 <br />Dale:2024.04.04 Brion .-OT00' <br />Signature of Applicant - Title Date <br />