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~',"_t.,'S ,t\,\.:JCJ .i\Gdih "OU 1"1 r y <br />APPLICATION FOR EIIICROACHMENT PERMJ1i DEC 23 ,il;!;8;3L, <br />To:San Joaquin County <br />Department of PublicWorks. <br />AT&T /Sherry Parks (Permits Desk) <br />(Applicant Name) <br />5555 E.Olive Ave <br />(Mailing Address) <br />AT&T JobJl AOOA2WY <br />OFFICEUSEONLY <br />JOB#7JOO79'REFillAPNCRillEXP.DATE ~~{jVALID~-1,{6 DRIVEWAYS:STREET [*~!d •AREA $-mrldon QUAD (7$•. <br />TYPE TJ'"'foch •FORMS ')5 "Vi;V Rl1NOTES <br />n <br />PLEASE PRINT: <br />Dme 12/17/2015 <br />Fresno,CA 93727 <br />(City,State,Zip Code) <br />(559)454-4900 g2 6977@att.co <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Please see the attached drawings . <br />.A aOA ;)..WY <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the N .sideof Shaw Rd/approximately 1520 feel/mile feet <br />of E Fremont St.,,by performing the following work (description of work):Remove existing CAD,Pl.ace new CMPH,Place (1)3-e1ectrode ground bed in <br />dirt at new CMPH.Traffic control plan is in place for pole access. <br />Work will commence on or about 12/23/2015 for approximateiy 1 0 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 />\"2..-I<6~t..O\S- <br />Date <br />M.\CENTRALSERVlCESlClERlCAlII'UB-SV,WKIMASTERPS\ENCROACHMENT PERMIT APPlICATION,DOC (09113)