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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/522 <br />To: San Joaquin County <br />Department of Public Works <br />Frontier Comm unitcairon c/o Ridgeline Telecom <br />(Applicant Name) <br />3230 E Imperial Hwy, Suite 310 <br />(Mailing Address) <br />Brea, CA 92821 <br />(City, State, Zip Code) <br />(714) 509 0068 <br />(Area Code - Telephone Number) <br />ftrpermits@ridgelinetel com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <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 />9/5/2022 TO 11/5/2022 DRIVEWAYS: <br />Wetherbee Ave. <br />Manteca QUAD SW <br />Bell Holes, Bores, Aerial Work <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 South side of wememee Avenue bea,een S oak Street and Ash Lane approximately C)feef/Qmile <br />of — — — — — — — — — _, – — — — — _, by performing the following work (description of work): <br />Work crew will bore +/- 655 LF to install con du it for the purpose of placing and splicing new fiber optic cable. Will place (1) new flowerpot and (1) new <br />17",30" hand hole WIII remove and replace 1 Sort of asp hel[ Vell access 24 existing False to even ash new fiber an Williamson Rd, Oak St, Ash Ln, VellowAve. <br />Will set no corresponding traffic control Der County of San Joaquin standards. <br />Work will commence on or after_ — — — 9/5/22 _ _ _ _ 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 />8/522 <br />Signature of Applicant - Title <br />Date <br />