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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/21/23 <br />To: San Joaquin County <br />Department of Public Works <br />Jenna Ortega / SEFNCO Communicaions <br />(Applicant Name) <br />12687 S Manthey Rd <br />(Mailing Address) <br />Lathrop, CA 95330 <br />(City, State, Zip Code) <br />(209) 817 4566 <br />(Area Code - Telephone Number) <br />JenOrtega@SEFNCO com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <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 />TO bi 5j2O2,f--DRIVEWAYS: <br />lfan. Ave. and VValkertrr <br />Stockton QUAD <br />Traffic Control Devices <br />SSfVVVV <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 — — _DANA Ave_ _ _ _approximately_ — — _C)feef/Qmile_ — <br />of — — — — _ --- __________- by performing the following work (description of work): <br />SPLICE AT 2 EXISTING COMCAST EQUIPMENT LOCATIONS IN THE SJ COUNTY ROW <br />Work will commence on or after_ — — — e/s/zs _ _ _ _ for approximately_ — 1— _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 />42123 <br />Signaturky Applica -Title <br />Date <br />