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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 03/02 2015 <br /> Date / OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 QQ 7 q REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1r,'_JS' j S <br /> AT&T/Sherry Parks (Permit Desk) VALID 4- -!S` TO DRIVEWAYS: <br /> (Applicant Name) STREET */k <br /> AREA -fpc UAD >E- <br /> 5555 E. Olive Ave. TYPE <br /> (Mailing Address) FORMS �Ay <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 /> Traffic Control Plan needed for aerial work. See attached drawings. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the West side of S. Austin Rd. approximately 2040 feet/mile North <br /> of Lynch Rd _ by performing the following work(description of work): <br /> lashing telecommunications cable to existing facilities across S. Austin Rd. <br /> Work will commence on or about 03/09/15 for approximately 30 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 /> n � �n e c _Sig ure of Applicanr_1 i 1 Stt�r Date <br /> M:ICENTRALSERVICESICLERICALIPUB-SV WKIMASTER.PMENCROACHMENT PERMIT APPLICATION DOC (09117) <br />