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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 09/12/19 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T / VCC PERMITS DESK <br />(Applicant Name) <br />A <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 COPT' OF THE I RAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT-; <br />SEE ATTACHMENTS <br />John McDowell <br />(209) 578-7155 <br />The undersigned hereby applies for permission to excavate, construct antllor otherwise encroach on County Highway Right-of-Wa on <br />the EAST side of S AIRPORT WAY approximately 65 ee mile NOR�'H <br />of STIMSON ST by performing the following work scription of work): <br />ACCESS SPLICEBOX# 1374 TO SPLICE EXISTING FIBER CABLE. THE ASSOCIATED TCP IS <br />SUBMITTED WITH PERMIT FOR AT&T JOB# A01 NTTL. <br />Work will commence on or about 19/14/?019 - 11 /14/2019 for approximately 2 clans days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and <br />agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County antl subject to inspection and approval. <br />-Title <br />Engineering <br />Signature of Ap <br />Administrator <br />Id:ICENTRALSERVICE9CLERICALIPUB-SV.WKNIASTER.PSIENCRDACHMENT PERMIT APPLICATIDN.DGC (09173) <br />09/13/2019 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />7 0 REF # <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />REA <br />QUAD <br />TYPE <br />FORMS <br />NOTES <br />A COPT' OF THE I RAFFIC CONTROL PLAN IS SUBMITTED WITH THIS PERMIT-; <br />SEE ATTACHMENTS <br />John McDowell <br />(209) 578-7155 <br />The undersigned hereby applies for permission to excavate, construct antllor otherwise encroach on County Highway Right-of-Wa on <br />the EAST side of S AIRPORT WAY approximately 65 ee mile NOR�'H <br />of STIMSON ST by performing the following work scription of work): <br />ACCESS SPLICEBOX# 1374 TO SPLICE EXISTING FIBER CABLE. THE ASSOCIATED TCP IS <br />SUBMITTED WITH PERMIT FOR AT&T JOB# A01 NTTL. <br />Work will commence on or about 19/14/?019 - 11 /14/2019 for approximately 2 clans days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and <br />agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County antl subject to inspection and approval. <br />-Title <br />Engineering <br />Signature of Ap <br />Administrator <br />Id:ICENTRALSERVICE9CLERICALIPUB-SV.WKNIASTER.PSIENCRDACHMENT PERMIT APPLICATIDN.DGC (09173) <br />09/13/2019 <br />Date <br />