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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date February 2, 2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# (,�^13b�j� -N REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -I~20/� <br /> Sherry Parks (AT&T Permit Desk) VALID 9-(y 7�i,�TO -,212 <br /> DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 5555 E. Olive Ave. AREA <br /> TYPE S <br /> (Mailing Address) FORMSA <br /> Fresno, CA 93727 NOTES <br /> (City,State,Zip Code) <br /> (559) 454-4900 <br /> (Area Code•Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Please see the attached TCP for work location. <br /> Contact the AT&T engineer with any questions. <br /> Debbie Sneed (559) 739-6646. <br /> AT&T job #A00323Y <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 'TGE oC'ul; bp"e approximately feet/mile <br /> of by performing the following work(description of work): <br /> work to include opening manhole and splicing fiber cables, innerduct/structure and cable <br /> plarpment to take nlare <br /> -T <br /> Work will commence on or about 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 /> E r1 c i r1 e e- r I r)C <br /> C J <br /> Sign ure of Applicant-Title Date <br /> MICENTRALSERVICEMCLERICALTUMV.WICMASTER.PS%ENCROACNMENTPERMITAPPLICATION.DOC(0903) <br />