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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/23/2023 <br />To: San Joaquin County <br />Department of Public Works <br />Comcast/SEFNCO Communications <br />(Applicant Name) <br />12687 S Manthey Rd <br />(Mailing Address) <br />Lathrop, CA 95330 <br />(City, State, Zip Code) <br />209-319-3104 <br />(Area Code - Telephone Number) <br />sysaelee@sefnco.com / adtrevino@sefnco.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 side of Cherokee Rd, Wigwam Dr, LAnce Dr, Teepee Dr, approximately Q feet/ Q mile <br />of Tomahawk nr, Auto Ave, _ by performing the following work (description of work): <br />i ie mo exisung vauir ana overpuii vuau or caDie rnrougnour uneroKee inausrnai rarK in exisung conauir, Dore .s-izLrDenina me curb <br />Work will commence on or after 7/5/2023 for approximately 10 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 />�i/_�ie VLLrLGY.V <br />S nieSa Saelee /Permit Supervisor <br />Signature of Applicant - Title <br />5/23/2023 <br />Date <br />