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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To:San Joaquin County JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code -Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 Date <br />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />110005 <br />9/15/2024 12/15/2024 <br />Alpine Rd. <br />Trench (dirt shoulder) <br />SS/WW, R-29 <br />Special Conditions <br />3/8/2024 <br />Pete Manas / Epic Wireless <br />605 Coolidge Drive, suite 100 <br />Folsom, CA 95630 <br />(530) 383-5957 <br />pete.manas@epicwireless.net <br />see attached site plan <br />East N Alpine Road 30'+/- <br />trenching for fiber and power conduits <br />TBD TBD <br />Construction Manager 3/8/2024