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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/02/17 <br />To: San Joaquin County <br />Department of Public Works <br />AT&T / VCC 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 />may be <br />OFFICE USE ONLY <br />JOB# REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />PLEASE SEE THE ATTACHED PERMIT DRAWINGS FOR AT&T JOB# A014DPP. <br />This permit application is to add to or revise permit PS -1703357 <br />We need to place approx. 45' of conduit that was missing from our records. <br />PLEASE EXPEDITE!! <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighPfee <br />Right-of-Way on <br />the SOUTH side of LOWELL AVE approximately 173 mile WEST <br />of EL DORADO ST by performing the following work (ription'of work): <br />DIG (1) 41.X4' PIT TO LOCATE EXISTING DUCT, PLACE WYE CAST, PLACE 45, 1 -4 - <br />DUCT VIA TRENCH. THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE <br />SEE THE ATTA H •D PERMIT DRAWINGS OR AT&T JOB4 A014nPP- <br />Work will commence on or about 1/21/2017 COMP: 02/21/2018 forapproximately 3 days 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 />Engineering Administrator 11/06/2017 <br />Signature of Apfficant - Title Date <br />(OW13) <br />