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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 03/24/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# S REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ( "( - <br /> Zayo Group c/o Monica Pina VALID 6-16-15 TO to-( -(S DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA I'At,i QUAD <br /> 2700 Merced St, San Leandro, CA 94577 TYPE <br /> are <br /> (Mailing <br /> (Mailing Address) FORMS fsZ �/y/ �2Z <br /> NOTES <br /> (City,State,Zip Code) <br /> 916-804-0573, monica.pino@zayo.com <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Please see attached TCP&drawings. <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 Lammers Rd approximately feet/mile <br /> of by performing the following work(description of work): <br /> Verify, rod and rope existing AT&T conduit. Setup traffic control to place Zayo owned fiber optic cable in AT&T leased <br /> conduit structure. For VZ3 Pleasanton Phase 3 Rings. <br /> Work will commence on or about 04/06/15 for approximately days. <br /> 15 <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 /> 1 _ 03/24/15 <br /> Signature of Applicant-Tiffe Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />