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A059BZF <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/23/25 <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 />SEE ATTACHED DRAWINGS <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the SOUTH side of W BENJAMIN HOLT DR. approximately 180 (F) feet/ ® mile S/W <br />of ALEXANDRIA PL. 1 6625 ALEXANDRIA PL 2224 W BENJAMIN HOLT DI by performing the following work (description of work): <br />TCP NEEDED FOR SHOULDER CLOSURE TO ACCESS XB PEP & BV #2204 ON ALEXANDRIA PL AND MH #804 ON W BENJAMIN HOLT DR <br />AT&T JOB A059BZF <br />Work will commence on or after 7/21/25 for approximately 1 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 />6/23/25 <br />Signature of Applicant - Title Date <br />