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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date February 16,2016 OFFICE USE.ONLY '~""''...::-.;\:. <br />To:San Joaquin County <br />Department of Public Works <br />ZAya Group <br />(Applicant Name) <br />2700 Merced Street <br />(Mailing Address) <br />San Leandro,CA 94577 <br />(City,State,Zip Code) <br />(916)217-3637 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />J08# <br />APN <br />EXP,DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />l/o<JO.>REF# <br />CR# <br />f,-/-/{;, <br />3-3/-1£_T'O [,-1-/6_ <br />I PlI??/Yl {Jr S <br />T,c 111C II QUAD 5"k/&ci?~5 w W 1<2'1 <br />DRIVEWAYS: <br />The undersigned hereby appiies for permission to excavate,construct and/or otherwise encroach on County Hi9~i9ht-of-Way on <br />the west side of S Lammers Road approximately 1,700'fee i1e North <br />of Redbridge Road C Tracy,CA ,by performing the following work (description of work): <br />Work crew to access (22)utility poles and lr-eaarand place approximately 500'of conduit and (1)hand hole and set <br />up corresponding traffic control.Work crew to then install fiber optic cable to provide service to a customer. <br />Work will commence on or about 03/01/2015 for approximately 60 days, <br />February 16,2016 <br />Date <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 a e in acc ce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />/7, <br />E",PUB-SV.WI(Il,IASTERPSlEHCROACHUENT PERWT APPlICATION,DOC (Ol.08)