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" <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 7/12/16 OFFICE USE ONLY <br />. <br />To:San Joaquin County <br />Department of Public Works <br />AT&T /Sherry Parks (Permits Desk) <br />(Applicant Name) <br />5555 E.Olive Ave <br />(Mailing Address) <br />Fresno,CA 93727 <br />(City,State,Zip Code) <br />('559)454-4900 g26977@att.con <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />JOB #2:ZcO?Cf REF # <br />APN CR# <br />EXP.DATE Gf-/-!C; <br />VALID 8'-2..-t'6 TO 9-(-10 DRIVEWAYS: <br />STREET (:hI)!')er ,. <br />AREA +'*Cd'0 QUAD IVJ~.TYPE ~kdt;i' <br />FORMS'WW R29'keiL¥ff1a! <br />NOTES <br />See attached drawings for details. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right,of-Way on <br />the Center side of \AI i3anner 5t approximately 80'feet/mile _ <br />of Thornton Rd ,by performing the following work (description of work): <br />Dig (2)4'x4'access pits in order to expose and repair existing conduit connecting 5B4 to SB5.See attached <br />drawings for details.AT&T job#AOOE8WV. <br />Work will commence on or about ~8~/~22=/~1~6 for approximately 5 days. <br />I,the undersigned,certify that I am the owner of tile 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 />£,l'I/~e'7A/ <br />icant •Title <br />M:\CENTRALSERVlCES\CLERICALlpIJB.SV.WK\MASTERPS\ENCROACliMENT PERMIT APPLICATION.DOC (09113)