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APPLIGAi°ION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 08/27/2019 <br />To; all Joaquin County <br />Department of Public Works <br />Frontier Ca Inc <br />(Applicant Name) <br />201 Flynn Road <br />(Mailing Address) <br />Camarillo CA 93013 <br />(City, State, Zip Code) <br />805-290-0977 <br />(Area Code - Telephone Number) <br />leticia.mattson@cyient.com <br />(Email Address) <br />OFFICE USE ONLY <br />JOB # REF # <br />AFIN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />See aLLached TCP <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East and West side of Jack Tone Rd approximately 890 feet/tspitec South <br />of Yosemite Ave by performing the following work (description of work): <br />Bore and place new 1.25" Sub -duct under the road approx. 36ft across Jack Tone Rd to place a new service drop cable for a new <br />Customer at 18147 Jack Tone Rd., South of Yosemite Ave. <br />FRONTIER 001 70244 W0782745 <br />Work will commence on or after 8/30/2019 for approximately 2 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 />Y:IPORIdS 8 TEMPlATE81EIJCROACHIdE14T PERMIT APPLICATIOIJ.doc (08108) <br />08/27/2019 <br />