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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 06/19/23 <br />To: San Joaquin County <br />Department of Public Works <br />Huynh Nguyen for Comcast <br />(Applicant Name) <br />3011 Triad PI <br />(Mailing Address) <br />Livermore, CA, 94551 <br />(City, State, Zip Code) <br />949-259-5203 <br />(Area Code - Telephone Number) <br />CHC-NodeSegPermit-3 ochcconsulting.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREETeessfLn. <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />712812023 TO DRIVEWAYS: <br />Stockton QUAD NVV <br />einaafVOorcF <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 4200 West Ln approximately 25 feet/mile southeast <br />of Postal Ave , by performing the following work (description of work): <br />Work will commence on or after 07/28/23 <br />for approximately 1 DAY 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 />06/19/23 <br />Signatua of Applicant Title <br />Y:IFORMS & TEMPLATESENCROACHMENT PERMIT APPLICATION. doc (08108) <br />Date <br />