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APPLICATION FOR ENCROACHMENT PERMIT <br />OFFICE USE ONLY <br />JOB #77007&1 REF# <br />APN CR# <br />EXP.DATE 4-($-II. <br />VALID 3-15'-(6 TO f-IH6 DRIVEWAYS: <br />STREET r/a/rl/lt,• <br />AREA frl?!'lChC~e QUAD • <br />TYPE • <br />FORMS <br />NOTES <br />IT <br />To:San Joaquin County <br />Department of Public Works <br />Fresno,CA 93727 <br />(City.State.Zip COde) <br />(559)454-4900 g26977@att.co <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />5555 F.Olive Ave <br />(Mailing Address) <br />PLEASE PRINT:~b <br />Dale $-..1&/lR~I <br />AT&T /Sherry Parks (Permits Desk) <br />(Applicant Name) <br />AoOB~M~ <br />Please see the attached drawings <br />The undersigned hereby applies for oermission to excavate,construct and/or otherwise encroach 00 County Highway Right-of-Wav on <br />the side of Harlan Rd approximately 528 feeUmile feet <br />of W Transportation Ct ,by performing the following work (description of work): <br />-Traffic control plan is in effect for splice box #1254 access and pole-- <br />-access with aerial crossing.Job #AOOB8M1 <br />Work will commence on or about __03/14/2016 for approximately _1_4 days. <br />\ <br />I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />~\~U~4 /ItA-oM iu t."ke,..{.o\.$I V /V <br />Ignature of Applicant -Title Diite I <br />MICEmAALSERVlCESlQ..ERICALIPUf>.SV.WK1W.STERPS'8lCROACHI.'ENT PERMIT APPlICATlON,DOC (WI13)