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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT:AT&T Job#AOOB067 <br />OFFICE USE ONI.Y <br />JOB#7?OO29'REF # <br />APN CR# <br />EXP.DATE 4-1-/6 <br />VALID 3-1f-11,TO 4-1-/6 DRIVEWAYS: <br />STREET ;:~IAe • <br />AREA y..;;cjT QUAD SIJV'• <br />TYPE Bore • <br />FORMS S~WW 2.2..., <br />NOTES <br />n <br />To:San Joaquin County <br />Department of Pubiic Works <br />Dme 02/LJ/2016 <br />5555 E.Olive Ave <br />(Mailing Address) <br />Fresno,CA 93727 <br />(City,State,Zip Code) <br />(559)454-4900 g26977@att.co <br />(Area Code.Telephone Number) <br />AT&T /Sherry Parks (Permits Desk) <br />(Applicant Name) <br />Sketch (Detailed plans may be submitted). <br />PLEASE SEE ATTACHED DRAWINGS <br />The unrtersigned hereby applies for oermission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way onthe.w .~irlAof Linne Rd approximately feeUmile _ <br />of Chr J.sman Rd ,,by performing the following work (description of work): <br />Place (3)3-electrode ground beds in dirt at poles 8318,7596 and 7594. <br />Traffic control plan is .in place for pole access.with aerial road crossing. <br />Work will commence on or about __0_3_/_0_9_/_2_0_1_6 for approximately 1_4 days. <br />a-I a-ao/to <br />Date <br />I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree "todo the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and aplJOval. <br />Engine-e.rirl9-AdrY\:n r st('(xf-gy <br />y