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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10/01/14 OFFICE USE ONLY <br /> To: San Joaquin County JOB# o Q 6U REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z- -t6 <br /> Verizon VALID —ZZ Lot TO 11-1 DRIVEWAYS: <br /> (Applicant Name) STREET pwo ,2CA <br /> AREA PD1:1 QUAD _ <br /> 430 W. Center St. TYPE ROre <br /> (Mailing Address) FORMS 5/k/V R x_15 <br /> NOTES <br /> Manteca, CA 95336 <br /> (City,State,Zip Code) <br /> 209 239-0369 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached print <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the north side of W. Ripon Rd approximately 281 feet/mile east <br /> of S . Manteca Rd. by performing the following work(description of work): <br /> Trench (2) 1. 25" subducts at a minimum depth of 36" from the pole at the <br /> northeast corner of S. Manteca Rd and W. Ripon Rd, continuing east on <br /> W. Ripon Rd. approximately 1500 ' . Exact location of subduct within <br /> county right of waV will be determined after locating existing copper <br /> facilities . Subduct will carry fiber for interoffice facilities . <br /> Work will commence on or about 10/20/14 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 /> J-2 <br /> Signature of Applicant-Titl c bate <br /> M]CENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACKMENT PERMIT APPLICATION.DOC (09113) <br />