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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PENN 1: <br />We 10/17/2019 <br />To; San Joaquin County <br />Department of Public Works <br />AT&T / VCC PERMITS DESK <br />(AppPicant Name) <br />5555 E. Olive Ave <br />(Mailing Address) <br />Fresno, CA 93727 <br />(City, State, Zip CO <br />(559) 454-4900 g26977@att.cor� <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />A COPY OF THE I RAi=FIC CON I ROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS FOR PROJECT A01 NWVJ <br />Les Anderson <br />(559) 739-6591 <br />The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Wagon <br />the SOU�H side of ALISTIN RD approximately 615 ee mile EAST <br />of E MARIPOSA RD by performing the following work scription of work): <br />MH ACCESS ON AUSTIN RD AND POLE ACCESS ON E MARIPOSA RD PLEASE SEE THE ATTACHED DOCUMENT <br />FOR SPECIFIC LOCATIONS <br />Work will commence on or about 11/15/2019 To oa/ls/Zozo for approximately 4 DAYS 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 />Title <br />Engineering <br />Signature of Applic <br />Administrator <br />M:ICENTRALSERVICESICLERICALIPUB-SV.WK�MASTER.P5IENCROACHMEIJT PERMIT APPLICATION.DDC (09113) <br />10/17/2019 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />7;007 REF # <br />APN <br />CR # <br />EXR DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />AREA <br />QUAD <br />TYPE <br />FORMS <br />NOTES <br />A COPY OF THE I RAi=FIC CON I ROL PLAN IS SUBMITTED WITH THIS PERMIT; <br />SEE ATTACHMENTS FOR PROJECT A01 NWVJ <br />Les Anderson <br />(559) 739-6591 <br />The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Wagon <br />the SOU�H side of ALISTIN RD approximately 615 ee mile EAST <br />of E MARIPOSA RD by performing the following work scription of work): <br />MH ACCESS ON AUSTIN RD AND POLE ACCESS ON E MARIPOSA RD PLEASE SEE THE ATTACHED DOCUMENT <br />FOR SPECIFIC LOCATIONS <br />Work will commence on or about 11/15/2019 To oa/ls/Zozo for approximately 4 DAYS 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 />Title <br />Engineering <br />Signature of Applic <br />Administrator <br />M:ICENTRALSERVICESICLERICALIPUB-SV.WK�MASTER.P5IENCROACHMEIJT PERMIT APPLICATION.DDC (09113) <br />10/17/2019 <br />Date <br />