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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/17/2023 <br />To: San Joaquin County <br />Department of Public Works <br />SEFNCO (Comcast) <br />(Applicant Name) <br />12687 S. Manthey Rd. <br />(Mailing Address) <br />CA 95330 <br />(City, State, Zip Code) <br />209-490-3373 <br />(Area Code - Telephone Number) <br />adtrevino@sefnco.com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />990005 REF # <br />CR # <br />TO DRIVEWAYS: <br />Mariposa Rd. <br />Stockton QUAD <br />raol Devices <br />sS/WW <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 South side of E Mariposa Road approximately 18 feet/mile feet <br />of Silva Street , by performing the following work (description of work): <br />Access existing pole to Comcast equipment to perform splice and activation <br />Work will commence on or after 2/20/2023 for approximately 2/27/2023 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 />A, d ria. wl Tira rt:K& <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />2/17/2023 <br />Date <br />