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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/9/2022 <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 />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />12/2/2022 TO 1/1/2023 DRIVEWAYS: <br />Adelbert Ave. & Sinclair Ave. <br />Stockton QUAD ES <br />Traffic Control Devices <br />SS/WVV <br />Special Conditions <br />The unEAS I ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the side of 4205 FARMINGTON RD, STOCKTON approximately feet/mile <br />of ADELBERT AVE. & S SINCLAIR AVE , by performing the following work (description of work): <br />This project proposes place traffic control signage within COUNTY OF SAN JOAQUIN jurisdiction for work being <br />perrormea in me UAL i twiva ana city or a i uUn i uiv lunsaicuon. <br />Work will commence on or after 12/2/22 for approximately 1 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 11/9/22 <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />Date <br />