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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/09/23 <br />To: San Joaquin County <br />Department of Public Works <br />Marc Wiederhold for Comcast <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@chcconsulting.com <br />(Email Address) <br />may <br />See attached <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the SOUTH side of 6539 PACIFIC AVE approximately feet/mile <br />of , by performing the following work (description of work): <br />(J131333408) - This project proposes to tie in at county limits & overlash approx. 56' to existing pole <br />#2 via existing pole #1. Overpull approx. 841' from existing pole #2 to county limit via 2 existing peds <br />& 2 existing vaults on Gettysburg PI & Douglas Rd_ <br />Work will commence on or after 05/01/23 —for 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 />Permitting for Comcast 02/09/23 <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />Date <br />