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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/14/2022 <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 />may <br />See attached <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREETra�—eRd. <br />AREA <br />TYPEen�T <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />11/17/2022 TO 21112022DRIVEWAYS: <br />Tracy QUAD <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 North side of Grant Line Rd approximately 1590 feet/mile East <br />—EDT <br />of RD by performing the following work (description of work): <br />AqMT7Access existing Hole #1 for splicing on <br />GRANT LINE -177 - <br />Work will commence on or after 1111 fl2022ifor approximately 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 />�LGI'LILN_ 41319 YI'L Permitting for Comcast <br />A Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />9/14/2022 <br />Date <br />