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APPLICATION FOR ENCROACHMENT PERMIT <br />Date June 16, 2023 <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 />6/22/2023 TO 8/15/2023 <br />Sedan Ave. <br />Manteca QUAD SVV <br />Trench <br />SS/WW, R-29 <br />Special Conditions <br />To: San Joaquin County <br />Department of Public Works <br />TeleSpan Communications, LLC <br />(Applicant Name) <br />3888 State St.; Suite 204 <br />(Mailing Address) <br />Santa Barbara, CA 9310-1- <br />31U-(City, <br />(City,State, Zip Code) <br />805.451.6283 <br />(Area Code - Telephone Number) <br />tcotter@tspan. ne <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See accompanying drawings. <br />DRIVEWAYS: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the north side of Sedan Avenue approximately 2,600 feet feet/mile east <br />of South Main Street by performing the following work (description of work): <br />approximately 50' of utility trenchinq <br />Work will commence on or after April, 15, 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 />president June 16, 2022, <br />a ure of scant - Title Date <br />YAFORMS & TEMPLATE SEN CROACHMENT PERMIT APPLICATION doc (08108) <br />