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APPLICA TlON FOR ENCROACHMEtlT PERMIT <br />PLEASE PRINT: <br />Date <br />k San JOalfJinCOUniy <br />Oepar.ment of Public War1<s <br />ATT (SHERRY PARKS) <br />(Applic'ant Name) <br />5555 E OLIVE AVE <br />FRESNO CA 93727 <br />(City,State,Zip Core) <br />559-454-4900_.._._----------------lArea Coda.Tclephone NumlJer) <br />OFFIC;F,USE 6NI:i~~----- <br />JOB:2"i 00 79 REF~APlj ••--_.CR~~-----_.- <br />EXP.D,.,\lE -_'T~".1.:LH6_..-.-'-~-'-'-' <br />WolID J.::L,.C!£.-_TO ...1::.Lf.:l:f?_._DRrIE'l'IAYS: <br />STR=~N Sf Rf 1'?f,.,,~R.Q{.~.• <br />.'.fl.:;'.Monula...__OIJPD -ALV_'._. <br />TYPE Bare <br />FOFI.IS fS ltv 'tVI~S j <br />I-...~----~---------'-_.._-..---~--.~-I <br />.-------------. <br />THIS PORTION OF THIS JOB (ATT AOOSV01)REQUIRES A SAN JOAQUIN COUNTY <br />PERMIT TO PLACE 2-1"XS'SPIRAL ANCHORS AT 2 LOCATIONS AND 1-30'-4 WOOD <br />POLE AT 1 LOCATION.ALL LOCATIONS ARE E/O NORTHBOUND N 99 FRONTAGE RD <br />NIO E MORADA LN.SEE DRAWINGS ATTACHED.PLEASE CALL ATT ENGINEER JOHN <br />KOZINA (209-474-4254)WITH ANY QUESTIONS. <br />IL..,.~ <br />1M urx!gr~gnsdherebyr..plies for perrn;;~ion to e~~'{ate,con;~nd.M,',(t ot1el\\i~ercro~h an C{1;o~t~HigtYlr.q Rftr..of.Way onl1e5i~eor eppm'ima:e.)'_..1ee1"mi:e _ <br />af -.by prrl;lrm~ll1e foll;)'I,ing wcrk (destripbcfl of wo'!:)' <br />ALL LOCATIONS ARE E/O NORTHBOUND N 99 FRONTAGE RD NIO E MORADA LN. <br />SEE DRAWINGS ATTltCAE:D.P(E:ASECALL ATT ENG1NEER JOHN KozlNA <br />(209.47442S4).WITH 'ANY QUESTIONS.-_._----_._-------_._._------_.---_.-----------------~. <br />for appro~imafsly 3_0 ._days. <br />I.Lie w.derslgned.certi'l'lh~t 1.rr.lf'c {Yllrte!of the re~pec'jlfe~roperty,cr a.'Il qualified to rep~e-.er,llhs r;t.'lI'1er and agr~c to dof~e <br />\\':)1\descn1e.i ilOO'lain .cx:orcqnoo \.,;t~Liercles aefdre~:iata.s of S-ar,Joaquin Colmly .nd S'Jl:i~to inspectkl~ard app~. <br />Signature of Applicant.TllIo Dato