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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/28/22 <br />To: San Joaquin County <br />Department of Public Works <br />Sunny Thipsidakhom for Comcast <br />(Applicant Name) <br />3011 Triad PI. <br />(Mailing Address) <br />Livermore, CA, 94551 <br />(City, State, Zip Code) <br />619-625-6729 <br />(Area Code - Telephone Number) <br />CHC-Permitting-6@chcconsulting.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 />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />TO 4/15/2023 DRIVEWAYS: <br />McKinley Ave. <br />Lathrop QUAD <br />Aerial Work <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 EAST side of 11236 S McKinley Ave approximately 10 feet/mile FEET <br />of Roth Road , by performing the following work (description of work): <br />This project proposes to access Pole #1 for splicing on S MCKINLEY AVE. <br />Work will commence on or after 1/13/2023 <br />for approximately <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 />Permitting for Comcast <br />Signature of Applicant - Title <br />Y:IFORMS & TEMPLATESENCROACHMENT PERMIT APPLICATION. doc (08108) <br />10/28/22 <br />Date <br />