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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/21/2023 <br />To: San Joaquin County <br />Department of Public Works <br />CVIN, LLC <br />(Applicant Name) <br />7447 N palm Bluffs Ave., 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@cvin.com <br />(Email Address) <br />Sketch (Detailed plans may be s <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 />10/16/2023 TO 11 /16 DRIVEWAYS: <br />Murphv Rd. <br />Escalon QUAD SE <br />Bore, Bore Pits <br />SS/WW, R-29 <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 East side of Murphy Rd approximately 100' feet/mile feet <br />of SR 120 In Caltrans Row. , by performing the following work (description of work): <br />Fiber ODtic Broadband Connection for RIDon Fire District: <br />Install 2,664' of 1.25" HDPE Conduit & 4 -way future path via HDD bore method maintaining minimum of 48" cover. Install (2) <br />24X36X24 handholes and (2) marker Dosts alona this route. <br />Work will commence on or after 10/09/2023 for approximately 10 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 />Signature of Applicant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />9/21/2023 <br />Date <br />