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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County 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 Date <br />Comcast/SEFNCO Communications <br />12687 S Manthey Rd <br />Lathrop, CA 95330 <br />209-319-3104 <br />sysaelee@sefnco.com / adtrevino@sefnco.com <br />See attached. <br />3/2/2023 <br />north E Pine St 50 south <br />6011 E Pine St <br />Access 2 existing poles to perform maintenance work for Comcast services. <br />3/13/2023 1 <br />3/2/2023