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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/21/2023 <br />To: San Joaquin County <br />Department of Public Works <br />CVIN, LLC <br />(Applicant Name) <br />7447 N Palm Bluffs, Suite 105 <br />(Mailing Address) <br />Fresno, CA 93711 <br />(City, State, Zip Code) <br />559-554-9204 <br />(Area Code - Telephone Number) <br />dwilliams@c in.com <br />(Email Address) <br />may <br />Please see plans attached. <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />3/27/2023 TO 5/15/2023 DRIVEWAYS: <br />Mariposa Rd. & Pock Ln. <br />Stockton QUAD SZ— <br />Bore, Bore Pits, Trench <br />SS/WW, R-29, Trench Cut Policy <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the southwest side of Mariposa Rd/Pock Ln Intersection approximately 20' feet/mile <br />of Pock Lane , by performing the following work (description of work): <br />INTERCEPT EXISTING CVIN CONDUITS AT APPROX. 32" DOWN & V EDGE OF PAVEMENT. PLACE 24x36x24 HANDHOLE AND BRING EXISTING CVIN <br />CONDUITS INTO NEW HANDHOLE. DIRECTIONAL DRILL 118' PLACE (1) 1.25" HDPE DUCTS (1) 4 -WAY FUTURE PATH DUCT MAINTAIN MIN. 48" COVER <br />PLACE 24x36x36 HAN DHOLE AT STATION 1+18 PLACE AS FAR AWAY FROM EDGE OF PAVEMENT AS POSSIBLE <br />TRENCH 8' TO RISER PLACE (1) 1.25" HDPE DUCTS AND MULE TAPE MAINTAIN MIN. 48" COVER <br />Work will commence on or after 3/27/2023 for approximately 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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Dm se- E. wwia vv <br />Signature of Applicant - Title <br />Y]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />3/21/2023 <br />Date <br />