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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/04/19 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T / VCC PERMITS DESK <br />(Applicant Name) <br />5555 E. Olive Ave <br />(Mailing Address) <br />Fresno, CA 93727 <br />(City, State, Zip Code) <br />(559) 454-4900 g26977@att.corr <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITI-I THIS PERMIT; <br />SEE ATTACHMENTS <br />TvGt�, %nc,�d we l� <br />C?01) .�7o 71S5 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on <br />the NORTH side of W OAK ST approximately 143 fee ile EAST <br />of W ALICE AVE by performing the following work ( escription of work): <br />ACCESS MANHOLE# 2 TO SPLICE EXISTING FIBER CABLE, <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT FUR AT&T JOB# A01 PMF9. <br />Work will commence on or about 1J"l/21/2LL19 - 11/21/2n19 for approximately 2 days days. <br />,the <br />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 />Engineering <br />Administrator <br />Signature of Appli <br />fd:ICENTRALSERVICESICLERICALIPNI3-SV,WKIMASTER.PSIENCROACHMENT PERMRAPPLICATION.00C (03113) <br />10/04/2019 <br />Date <br />OFFICE USE ONLY <br />013# <br />17300 ? � REF # <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />TO DRIVEWAYS: <br />S <br />ATREET <br />REA <br />QUAD <br />TYPE <br />FORMS <br />NOTES <br />A COPY OF THE TRAFFIC CONTROL PLAN IS SUBMITTED WITI-I THIS PERMIT; <br />SEE ATTACHMENTS <br />TvGt�, %nc,�d we l� <br />C?01) .�7o 71S5 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on <br />the NORTH side of W OAK ST approximately 143 fee ile EAST <br />of W ALICE AVE by performing the following work ( escription of work): <br />ACCESS MANHOLE# 2 TO SPLICE EXISTING FIBER CABLE, <br />THE ASSOCIATED TCP IS SUBMITTED WITH PERMIT FUR AT&T JOB# A01 PMF9. <br />Work will commence on or about 1J"l/21/2LL19 - 11/21/2n19 for approximately 2 days days. <br />,the <br />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 />Engineering <br />Administrator <br />Signature of Appli <br />fd:ICENTRALSERVICESICLERICALIPNI3-SV,WKIMASTER.PSIENCROACHMENT PERMRAPPLICATION.00C (03113) <br />10/04/2019 <br />Date <br />