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APPLICATION FOR <br />PLEASE PRINT: <br />Date 10/30/2017' <br />ENCROACHMENT <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />PERMIT 'R E C E+'-' i:. J <br />Stied JOACUIf COUNT'r <br />OF ON Y <br />DEPT. OF r UOLIC t�ORXS <br />REE # <br />CR # <br />TO DRIVEWAYS: <br />To: San Joaquin County <br />Department of Public Works <br />AT&T/SHERRY PARKS/PERMIT DESK <br />(Applicant Name) <br />5555 E. OLIVE AVE <br />AREA <br />TYPE <br />QUAD <br />(Mailing Address) <br />FRESNO, CA 93727 <br />FORMS <br />NOTES <br />(City, State, Zip Code) <br />559-454-4900 g26977@att.com <br />(Area Code - Telephone Number) <br />(Email Address) <br />F <br />ch (Detailed plans may be submitted) <br />PLEASE SEE ATTACHED PERMIT DRAWING & TRAFFIC CONTROL PLAN <br />FOR AT&T JOB #AO15J5R <br />The undersigned hereby applies forermission to xc vate, construct andlor otherwise encroach on County Highway Right -of -Way on <br />the side of WMISHEWS f�D approximately 530' feet/mile EAST <br />of ��R , by performing the following work (description of work): <br />REPAIR TWO FOUR INCH CONDUITS ON POLE 397 AND REMOVE & REPLACE AN EXISTING <br />Work will commence on or after 11/07/2017 for approximately THREE 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 />`/ �1� '.Folli t � ��t ! 1 ie':' 1P°t C � F L E r , , r ✓'( d. T L•. y'` <br />Signat�(rJk of Applicant��;'�Tit}}le <br />YJFOWA1S ® TEMPNTESENCROACHMQJT PEWIITAPPLICAiION(dro7{OIflNB� <br />10-31-2017 <br />Date <br />