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, l <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/3/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 71'(S <br /> Zayo Group c/o Monica Pino VALID TO q–ham— DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA nz QUAD <br /> 2700 Merced St TYPE �7 v <br /> (Mailing Address) FORMS <br /> NOTES <br /> San Leandro, CA 94577 <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 drawings and traffic control plans. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of S Lammers Rd &Byron Hwy approximately feet/mile <br /> of ,by performing the following work(description of work): <br /> Furnish &install underground conduit(by directional bore or open trench), manholes, and splice boxes for fiber optic <br /> cable placement. Backbone Route Pleasanton 2.3 Locations H.2&K. <br /> Work will commence on or about ~ for approximately 120 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 Date <br /> E:IPUB&SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br />