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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/17/2023 <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 />110005 REF # <br />CR # <br />3/15/2023 TO 5/15/2023 DRIVEWAYS: <br />Schulte Rd., Patterson Pass Rd <br />Tracy QUAD SW <br />Traffic Control 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 side of approximately _ feet/mile <br />of Intarnatinnal PKWY, Patterson Way, V A Nirnln Rd SrhijlltP. Rd by performing the following <br />work (description of work): Tie into existing pole and overpull 1272' of cable to target building through existing riser and existing <br />conduit. All existing infrastructure. <br />Work will commence on or after for approximately 5 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, driY i N/ii Tina rt:K& <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />1/17/2023 <br />Date <br />