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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 03119/2020 <br />To: San Joaquin County <br />Department of Public Works <br />SEFNCO Communications <br />(Applicant tame) <br />12667 S. Manthey Rd. <br />(Mailing Address) <br />Lathrop, CA 95330 <br />(City, State, Zip Code) <br />(925)290-9475 <br />(Area Code - Telephone Number) <br />PHeusler@sefnco.com <br />(Email Address) <br />ed plans may be submitted) <br />OFFICE USE ONLY <br />JOB €f REF 9 <br />APN CR 9 <br />EXP. DATE _ ®+ <br />VALID �0 d DRIVEWAYS: <br />STREET <br />AREA y'/C QU D — <br />TYPE 4 z A/P&& <br />FORMS Q ... <br />NOTES "':5e <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the South side of Woodbridge Rd approximately .78 Ile West <br />of Taml Ln by performing the following work (description of work): <br />Delash/Relash 470' along Woodbridge Rd. <br />will commence on or after 04/99/2020 <br />for approximately 90 <br />days. <br />1, 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 describ above i ac rdance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br />U3/19/2020 <br />Signature of Applicant - Title Date <br />YFOR555 d TETSMTESOCRdACKWIII PfF0KTAftcAP0NdctMW1 <br />