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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To:San Joaquin County JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code -Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ______________ side of __________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant -Title Date <br />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />manholes, (1) existing sub box & (11) existing poles to remove unused copper cables for recycling. <br />(Addresses shown above) <br />8 loc. = 3801, 4529, 4833, 5610, 5730, 5823 E. Main St. & on Anteros Ave. at side of: 3801 E. Main St. <br />1 loc. = 4490 N. Wilson Way <br />1 loc. = 2300 N. Teepee Dr. <br />4 loc. = 3127 & 3131 E. Fremont St. <br />1 loc. = 3300 Waterloo Rd. <br />1 loc. = 1859 Cherokee Rd. <br />1 loc. = 3717 West Ln. <br />1 loc. = 837 Shaw Rd. <br />1 loc. = On Fairway Dr. at side of: 4108 Cliff Dr. <br />1 loc. = 9022 S. Roberts Rd. <br />This job is package 2 for job# A05577X <br />AT&T CALIFORNIA - VALLEY Permit Desk <br />1445 VAN NESS AVE. <br />Fresno, CA 93721 <br />(559) 552-4608 <br />g26977@att.com