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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: QS — 14 0095- <br /> F-WO- q344 GOO <br /> Date 12/13/2013 OFFICE USE ONLY <br /> To: San Joaquin County JOB# -' 3 D a 7 9 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE J-/1 �' <br /> AT&T James Jelly VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET At, -t i v, <br /> AREA , fa ckf QUAD $E <br /> 2300 E. Eight Mile TYPE Trtn( ; .42-42 <br /> (Mailing Address) FORMS �,r/T�_2 q <br /> Stockton CA 95210 NOTES <br /> (City,State,Zip Code) <br /> 209-474-4110 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached drawings and traffic control plan <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 Austin approximately 1,225- feet/mile north <br /> of French Camp , by performing the following work(description of work): <br /> Trench and place 3-1.25" conduits and service boxes for service requirements. Total trench footage 2,7261 . <br /> Work area 2-West side of Austin Rd. and Arch Rd. Trench and place 1-4" conduit and barrel vault. Total trench <br /> footage 871 . <br /> Work area 3-South side of Arch Rd. approximately 837' west of Austin Rd. Bore and place 1-4" conduit and se�1pe <br /> box. Total trench--footage 8261 . <br /> Work will commence on or about 1-7-2013 for approximately 45 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 /> Design Engineer/MGR <br /> Signatur of Appli t-Title Date <br /> 1PUB-SVNI(NASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (0108) <br />