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GwrVOdICATB®M FCR ENUMOALTIIVIlF11T limptK �l I <br />PLEASE PKINT: <br />Date 10/23/19 <br />To: San Joaquin County <br />Department of Public Works <br />Sydnie Saelee / TAK Communications CA Inc <br />(Applicant <br />425 Nortitgate Sl�rd <br />(Mailing Address) <br />Sacramento, CA 951334 <br />(tFitS�, State, Zip <br />916-514-9809 <br />(Area Code - Telephone Number) <br />ssaelee@takcornmunicationsca.com <br />(Email Address) <br />Sketch (Detailed plans may be <br />SEE ATi TACHE® <br />OFFICE USE ONLY <br />JOB # % ! Llod 57 REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE ' <br />FORMS <br />NOTES <br />i <br />Additi®nal Contact : Liv Ordaz 209-�QO-7074 iuisord <br />�ail.co,� <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Riyht-of-Way on <br />the North &south _ side of Waterloo Rd __approximately _ 330' ee ile west <br />Of N Filbert 5t by performing the following work (description of work): <br />'fie in at existing pole and overlash 90' of new cable from pole to pole across Waterloo Rd. <br />Work will commence on or after <br />12/2/'f 9 <br />for approximately <br />3 <br />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 />10/23/19 <br />Signatum of Applicant -Title <br />Y:IFORMS & TENPlATE51ENCfiOACHtAENi PEfMhIT APPLICATICN.dx (Ofl�O]) <br />Uate <br />