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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD * <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <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 ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 DateSignature of Applicant -T <br />See attached. <br />north CA-26 40'east <br />N Mill St <br />Place traffic control signage for work being performed in CALTRANS jurisdiction. <br />02/22/2022 1 <br />Permitting for Comcast <br />1/13/22 <br /> Sunny Thipsidakhom for Comcast <br /> 3011 Triad Pl. <br /> Livermore, CA, 94551 <br /> 858-761 5426 <br /> CHC-Permitting-6@chcconsulting.com <br />1/13/22