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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/07/22 <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-Permifting-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 />11(7/2022 TO DRIVEWAYS: <br />Joseph Rd. <br />Manteca QUAD SW <br />Aerial Work <br />SS/VVVV <br />Spec al Cond tons <br />The undersigned hereby applies forpermission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EAST — — _ side of sae Joseph Ra. _ _ __ approximately 6 _ _ _ _ feet/mile FEET_ <br />of JOSEPH RD _ by performing the following work (description of work) <br />This protect proposes to overlash approx. 6' of new Cable along 1 existing pole Upto R.O.W. <br />Work will commence on oratter 11m22 — — — — — — — _ for approximately 1 — — — – — _days. <br />I, the undersigned, certifythat I am the owner of the respective property, oram qualified to represent the owner and agree to clothe <br />work described above in accordance with the rules and regulations of San Joaquin County and subjectto inspection and approval. <br />5' ? � Permitting forComcast <br />61Signatureof Applicant -Title <br />urovus areurovESENCROACHMENT PERM T APPLICATION P.A(POPE) <br />10/07/22 <br />Date <br />