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PLEASE PRINT: <br />Date <br />To: San Joaquin County <br />Department of Public Works <br />Zayo Group, LLC, (James Small) <br />(Applicant Name) <br />75 E. Santa Clara St., <br />(Mailing Address) <br />San Jose, CA 95133 <br />(City, State, Zip Code) <br />(916) 207-3637 <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />See Attached Plans <br />-(4-0079 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of S. McKinley Ave. approximately 285 Feet feet/mile South <br />of Industrial Rd. by performing the following work (description of work): <br />Directional bore,.and place (3) 1.25" HDPE conduits to convey fiber optic cable Place (2) 4'x4' traffic rated MH's <br />Work will commence on or about March 2014 for approximately 30 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 decri dbove in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Rte' <br />i au a of Applicant - Title 4 L Date <br />M:ICENTRALSERVICESICLERICALIPUB&SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09113) <br />OFFICE USE ONLY <br />JOB # <br />REF# <br />APN <br />_[000 <br />CR # <br />EXP. DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />AREA <br />TYPE <br />MG Kr#�e�t/tlY'r+dss�x�,! �2✓� er�t ,iY <br />-� QUADAl <br />e { <br />FORMS <br />S__—Wr q <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of S. McKinley Ave. approximately 285 Feet feet/mile South <br />of Industrial Rd. by performing the following work (description of work): <br />Directional bore,.and place (3) 1.25" HDPE conduits to convey fiber optic cable Place (2) 4'x4' traffic rated MH's <br />Work will commence on or about March 2014 for approximately 30 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 decri dbove in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Rte' <br />i au a of Applicant - Title 4 L Date <br />M:ICENTRALSERVICESICLERICALIPUB&SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09113) <br />