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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 01/09/2018 <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 826977@att.com <br />(Area Code - Telephone Number) <br />may <br />SEE ATTACHED TRAFFIC CONTROL PLAN DRAWINGS FOR AT&T JOB A0166LX. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on <br />the W/E/E side of N GOLDEN GATE/N G. GATE/SUTRO approximately 150/385/13 fee mile N/S/S <br />of CHARLES ST/E HARDING WY/CHARLES ST by performing the following work ( escription of work): <br />PLACE GROUND BED CONSISTING OF (3)-8' GROUND RODS AT 4 POLE LOCATIONS, INCLUDING NEW ANCHORS <br />AT 2 LOCATIONS. ANEW POLE TO BESET OPPOSITE EXISTING POLE 18. TRAFFIC CONTROL PLAN FOR THIS WORK <br />AND THE PLACEMENT OF APPROXIMATELY 2700' OF AERIAL CABLE ALONG N GOLDEN GATE AND CHARLES ST. <br />THE GROUND BED PLACEMENTS WILL REQUIRE 1'X 18' TRENCHES AT THE FOUR POLE LOCATIONS. <br />Work will commence on or about _0112412019_EST COMP=04/24118 for approximately <br />5 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 ab e in acc dance with th u e and regulations of San Joaquin County and ubje t to inspection and approval. <br />r <br />Siginkur-INYAApplicant- Title Date <br />�M13, <br />OFFICE USE ONLY <br />JOB# <br />7REF# <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />AREA <br />QUAD <br />TYPE <br />FORMS <br />NOTES <br />SEE ATTACHED TRAFFIC CONTROL PLAN DRAWINGS FOR AT&T JOB A0166LX. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on <br />the W/E/E side of N GOLDEN GATE/N G. GATE/SUTRO approximately 150/385/13 fee mile N/S/S <br />of CHARLES ST/E HARDING WY/CHARLES ST by performing the following work ( escription of work): <br />PLACE GROUND BED CONSISTING OF (3)-8' GROUND RODS AT 4 POLE LOCATIONS, INCLUDING NEW ANCHORS <br />AT 2 LOCATIONS. ANEW POLE TO BESET OPPOSITE EXISTING POLE 18. TRAFFIC CONTROL PLAN FOR THIS WORK <br />AND THE PLACEMENT OF APPROXIMATELY 2700' OF AERIAL CABLE ALONG N GOLDEN GATE AND CHARLES ST. <br />THE GROUND BED PLACEMENTS WILL REQUIRE 1'X 18' TRENCHES AT THE FOUR POLE LOCATIONS. <br />Work will commence on or about _0112412019_EST COMP=04/24118 for approximately <br />5 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 ab e in acc dance with th u e and regulations of San Joaquin County and ubje t to inspection and approval. <br />r <br />Siginkur-INYAApplicant- Title Date <br />�M13, <br />