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APPLICATION FOR ENCROACHMENT PERMIT r <br /> PLEASE PRINT: <br /> Date 10/28/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# j (,(22q 2q REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> AT&T / Sherry Parks (Permits Desk_) VALID ( ( -a'(S TO ./.,DRIVEWAYS: <br /> (Applicant Name) STREET A -3 <br /> AREA QUAD <br /> 5555 E. Olive Ave _ TYPE C <br /> (Mailing Address) FORMS Z <br /> NOTES <br /> Fresno, CA 93727 <br /> (City,State,Zip Code) <br /> (559) 454-4900 g26977@att . coir <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Please see the 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 S side of Newton Rd approximately 285 feet/mile feet <br /> of E Stevenson Ave by performing the following work(description of work): <br /> P1are 84 ' of Flu rt via trench _ P1Pase see attarhPd drawings <br /> Work will commence on or about 11 0 4 2 015 for approximately bdays, <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 n�{'i ✓1 '��✓ t 1'l�' <br /> Signat of Applicant-Title r Date <br /> MICENTRALSERVICESICLERICALIPUB-SV.WKIMASTERRMENCROACHMENT PERMIT APPLICATION DOC (09/17( <br />