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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/23/23 <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-Permifting-6@chcconsulting.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 />110005 REF # <br />CR # <br />312912023 TO 51112023 DRIVEWAYS: <br />west Ln. <br />—SInn QUAD NS <br />Traffic Control Devices <br />SSMW <br />Special Conditions <br />The undersigned hereby applies forpermission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the — — — _ side of — — — — approximately — — — _ feet/mile — <br />of — — — — — ,— — by performing the following work (description of work): <br />Near intersection of West Ln and E Alpine Ave <br />Work will commence on or after 03149143_ _ _ _ _ for approximately 1 DAY _ _ _ _ _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 />/Al• 4 PermiHing for Com cast <br />Signature of Applicant - Title <br />urovus areurovESENCROACHMENT PERM T APPLICATION P.A(POPE) <br />02/23/23 <br />Date <br />