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APPLICATION FOR ENCROACHMENT PERMIT <br />2m3fli\'j -5 M'1\\:33 <br />....,\\"'1"00':'3"1'T f,(,.,.'~,.".,.',. <br />OFFICE USE'ONL Y <br />JOB#730r1?7 REF#. <br />APN CR# <br />EXP.DATE r<--I ~If) <br />VALID C -f -7£TO 1l-t-!{;DRIVEWAYS: <br />STREET ,/VI17(IIV'• <br />AREA f8~1rPQUAD <br />(C-• <br />TYPE • <br />FORMS L~1<7/1 <br />NOTES <br />STOCKTON CA 95210 <br />(City,State,Zip Code) <br />209-474-4052 <br />(Area Code -Telephone Number) <br />AT&T <br />(Applicant Name) <br />2300 E EIGHT MILE RD <br />(Mailing Address) <br />Date 5-4-16 <br />To:San Joaquin County <br />Department of Public Works <br />PLEASE PRINT: <br />Sketch (Detailed plans may be submitted) <br />PLEASE SEE ATTACHED DRAWINGS <br />AT&T JOB#AOOA8CN <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County HighwayRight-of-Wayon <br />the EAST side of MISSION RD approximately 123FT feeUmile NORTH <br />of ELMWOOD AVE CENTERLINE ,,by perfonmingthe followingwork(description ofwork): <br />place a 5'x4'x6"concrete pad with cabinet template.Trench and place 6ft of 2-4"conduits from pad to existing <br />utility pole.place a 41"hx43"wx20"d cabinet on pad.All excavation will be done in dirt landscape area.No <br />concrete or ashpalt to be disturbed Restore aU surfaces to like or better <br />Cost of Labor in ROW =$3200 <br />Workwillcommence on or about between 6-1-16 to 8-1-16 for approximately 4 days days. <br />S-"4 -("- <br />Date <br />--- <br />I,the undersigned,certifythat I am the owner of the respective property,or am qualifiedto represent the owner and agree to do the <br />work described above in accordance withthe rules and regulations of San Joaquin County and subject to inspection and approval.I)j/~.:.c:::Signature 0pjliicant -Title <br />M'CENfRAlSERVICESIClERICAJ..IPU6-SV WK\MI\$TBl PS'ENCROACHMEN}PERMIT APPliCATION DOC Pl/131