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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/23/23 <br />To: San Joaquin County <br />Department of Public Works <br />Marc Wiederhold for Comcast <br />(Applicant Name) <br />3011 Triad PI. <br />(Mailing Address) <br />Stockton, CA, 95210 <br />(City, State, Zip Code) <br />858-898-0610 <br />(Area Code - Telephone Number) <br />CHC-Pennittin chcconstilting.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPEraiiffcZonTol <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />1/0005 REF # <br />CR # <br />Tp sn srzoza DRIVEWAYS: <br />o7Cve. <br />Manteca QUAD <br />Devices <br />SSI <br />Special Conditlons <br />The undersigned hereby applies forpermission 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 location: BELLA TERRA DR AND W WOODWARD AVE <br />Work will commence on or after 04/1M3 _ _ _ _ _ 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 />/r" �fc -4'Alq Permittingfor Comcast <br />Signature of Applicant - Title <br />urovus areuruTESENCROACHMENT PERM T APPLC,TIokme 08108) <br />02/23/23 <br />Date <br />