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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/04/23 <br />To: San Joaquin County <br />Department of Public Works <br />Marc Wiederhold <br />(Applicant Name) <br />3011 Triad PI. <br />(Mailing Address) <br />Livermore, CA 94551 <br />(City, State, Zip Code) <br />858-898-0610 <br />(Area Code - Telephone Number) <br />CHC-Permitting-6@congruex.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 />JB1455000 110005 REF # <br />CR # <br />TO 1/4/2024 DRIVEWAYS: <br />Harlan Rd <br />Lathrop QUAD SW <br />Trench, Bore, Bore Pits, Potholes, Aerial Work <br />gq/WW R -?9 <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 side of 9966 S HARMAN RD. approximately feet/mile <br />of , , by performing the following work (description of work): <br />Tie in at existing pole #1. Overlash approx. 158' from existing pole #1 to existing pole #2 and riser down. Hand trench & bore approx. 20' <br />& 554' to place 2-2" conduit & cable from existing pole #2 to existing pole #5 and rise up. Place new strand & lash new fiber cable approx. <br />169' from existing pole #5 to existing pole #6 and rise down. Hand trench & bore approx. 10'& 139' to place 2-2" conduit & cable from <br />existing pole #6 to county R.O.W. via 2 new Comcast vaults on S HARLAN RD. Place new riser at Pole #2 on S HARLAN RD. Access <br />Pole #7 for splicing on S MCKINLEY AVE. <br />Work will commence on or after 12/04/23 for approximately 6 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 />/ �" 014"",14 Permitting for Comcast 10/04/23 <br />Signature of Applicant - Title <br />Y:IFORMS & TEMPLATESENCROACHMENT PERMIT APPLICATION. doc (08108) <br />Date <br />