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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />OFFICE USE ONLY <br />JOB#7300£?REF # <br />APN CR# <br />EXP.DATE g-;-/6 <br />VALID ~-1£6 TO $-f-/6 DRIVEWAYS: <br />STREET •<:'oJ/tICAREAffrrk01 QUAD (C • <br />TYPE 1f~flhole • <br />FORMS 55wrv 622.9 <br />NOTES <br />2300 E EIGHT MILE RD <br />(MailingAddress) <br />STOCKTON CA 95210 <br />(City.State.Zip Code) <br />209-474-4052 <br />(Area Code.Telephone Number) <br />Date 5-4-16 <br />AT&T <br />(Applicant Name) <br />To:San Joaquin County <br />Departmentof PublicWorks <br />Sketch (Detailedplans may be submitted) <br />PLEASE SEE ATTACHED DRAWINGS <br />AT&T JOB#AOOA8CR <br />The undersigned hereby appliesforpermissiontoexcavate,construct and/or otherwise encroach on County HighwayRight-of-Wayon <br />the EAST side of N WEBSTER AVE approximately 149FT feet/mile NORTH of <br />W EUCLID AVE CENTER LINE ,by performingthe followingwork(descriptionofwork): <br />place a 40"'x4'x6"concrete pad with cabinet template,Trench and place 3ft of 1-4"conduit from pad to <br />existing 3'xS'underground splice vault.place 41h"x25w"x20d"cabinet on pad.All excavation to be done in <br />djrt landscape area No concrete or asphalt to he djsturbed Return all surfaces to ljke Of better <br />Cost of Labor in ROW =$3800 <br />Workwillcommence on or about between 6-1-16 TO 8-1-16 forapproximately 5 days. <br />I,the undersigned,certifythat I am the ownerofthe respectiveproperty,or am qualifiedto represent the owner and agree to do the <br />workdescribed above in accordance withthe rules and regulationsof San Joaquin Countyand subject to inspection and approval. <br />£Jj~5""-c;--{b <br />SiOio!A~Title Date <br />MICENTRAJ.SERVlCES\CLERlCAlV'Ue.SV I'IK'MASTffi PS'EI'lCI'OACHMENT PERMITAPPlICAT IONDOC (09/13)