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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/10/2021 <br />To: San Joaquin County <br />Department of Public Works <br />Marc Wiederhold for Comcast <br />(Applicant Name) <br />6505 Tam 0 Shanter Dr <br />(Mailing Address) <br />Stockton, CA, 95210 <br />(City, State, Zip Code) <br />858-395-2342 <br />(Area Code - Telephone Number) <br />CHC-Permitting-4@chcconsulting.com <br />(Email Address) <br />may <br />See attached <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPErenTT <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />8/1412021 TO 7/15/2021 DRIVEWAYS: <br />v9'atewu Rd <br />cKron QUAD <br />Pits, BoresPo ores, Aerla—1 o� <br />SSANVV, R-29, R-5, R-7, Trench Cut Policy <br />Special Conditions <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 Waterloo Rd, west side of Chronicle Ave. approximately feet/mile <br />of , by performing the following work (description of work): <br />Tie in at existing pole #1 and overlash approx. 522' to existing pole #4 on Waterloo Rd. <br />Tie in at existing pole #4 riser down and trench approx. 33' and bore approx. 420' to existing pole #6 riser up via existing pole #5 on Waterloo Rd. <br />Tie in at existing pole #17 riser down and trench approx. 16' and bore approx. 264' to existing pole #19 riser up bypass via pole #18 on E John ST. <br />Tie in at existing pole #6 overlash approx. 1603' to existing pole #17 via 10 existing poles on John ST. <br />Access Ped #1 for splicing on Cherokee Rd. Access Pole #21 & 22 fors Icing on Auto Ave. <br />Work will commence on or after 6/14/2021 for approximately 6 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 />mam wie-d rho -(d <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />5/10/2021 <br />Date <br />