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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 06/08/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7;7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE C/-/ -/ � <br /> AT&T / Sherry Parks (Permits Desk) VALID -1 TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA Lc) 1 QUAD _l <br /> 5555 E. Olive Ave TYPE <br /> ee- <br /> (Mailing Address) FORMS <br /> NOTES T <br /> Fresno, CA 93727 <br /> (City,State,Zip Code) <br /> (559) 454-4900 <br /> (Area Code-Telephone Number) <br /> g269777@att. com <br /> Sketch (Detailed plans may be submitted) <br /> � 0069 KCS <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-o'-Way on <br /> the side of Alpine Rd. approximately 2640 feeVmile feet <br /> of r,l jTP na k R� by performing the following work(description of work): <br /> Dig (1) 4x4 reveive pit, Dig (2) 4x4 bore pits, Dig (1) 4x6 receive pit, PL <br /> 84 ' of 1-4" duct via bore, PI 9 ' of 1-4" via trench, Pi (1) 3x5 SB, PL (1) <br /> 3-elecrtode ground bed in grass, pl (2) 3­electrode ground beds in dirt. <br /> Traffic control plan is in place for excavation and pole access. Please <br /> see attached drawings <br /> Work will commence on or about 0 6/15/2()1 5 for approximately 3 0 day s. <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 /> - - aC ) <br /> Signature Applicant-Title Date <br /> M]CENTRALSERVICESICLERICALIPUB�SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09113) <br />