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APPLICATION FOR ENCROACHMENT PERMIT,'° <br /> PLEASE PRINT: <br /> Date 09/15/2015 OFFICE USE ONLY - <br /> To: San Joaquin County JOB# 737007C/ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 12- 1 � I � <br /> SHERRY PARKS FOR AT&T VALID 10^ IQ-14 TO t �-( -(.S DRIVEWAYS: <br /> (Applicant Name) STREET 019C1 //�� //++ <br /> AREA A QUAD //� <br /> 5555 E OLIVE AVE TYPE f� � -�-- <br /> (Mailing Address) FORMS Z <br /> NOTES <br /> FRESNO, CA,93727 <br /> (City,State,Zip Code) <br /> 559-454-4900 G26977@ATT.COM <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted)PROJECT A007SRM <br /> MAJOR CROSS STREETS E KETTLEMAN LANE AND E HARVEY LANE <br /> TRENCH AND PLACE 25'OF 1 1/4" INNERDUCT IN GRASS/DIRT AT 13823 N BECKMAN RD FOR <br /> CHEROKEE MEMORIAL PARK <br /> SEE ATTACHED PERMIT AND TCP <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the NORTH side of BECKMAN ROAD approximately 25 feet/mile FEET <br /> Of 1 1/4" INNERDUCT _, by performing the following work(description of work): <br /> TRENCH AND PLACE 25'OF 1 1/4"INNERDUCT IN GRASS/DIRT AT 13823 N BECKMAN RD FOR <br /> CHEROKEE MEMORIAL PARK <br /> Work will commence on or about—og/25/15 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 /> Si <br /> nature of Applicant-Title Date <br /> M.ICENTRALSERVICESICLERICALIPUMV.WRIMASTER-PSTNCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />