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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/30/23 <br />To: San Joaquin County <br />Department of Public Works <br />Jenna Ortega / SEFNCO Communicdions <br />(Applicant Name) <br />12687 S Manthey Rd <br />(Mailing Address) <br />Lathrop, CA 95330 <br />(City, State, Zip Code) <br />(209) 811-0566 <br />(Area Code - Telephone Number) <br />JenOrtega@SEFNCO com <br />(Email Address) <br />may <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 />1/29/2024 TO 4/2/2024 DRIVEWAYS: <br />Swain Rd. <br />Stockton QUAD LV <br />Aerial wn�k <br />SS/WW <br />rwdifl— <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 — — wswAIIV HD_ _ _ _approximately <br />— — — _()feet/()mile— <br />of — — — — _ --- __________- by performing the following work (description of work): <br />SPLICE AT 1 EXISTING COM CAST EQUIPMENT LOCATION IN THE SAN JOAQUIN COUNTY ROW <br />Work will commence on or after_ — — — 1/29/24— — — _ 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 />A& 11/3023 <br />Signature of licant - Title Date <br />