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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/13/24 <br />To: San Joaquin County <br />Department of Public Works <br />Suzette Barron/SEFNCO Communications <br />(Applicant Name) <br />12687 S. Manthey Rd. <br />(Mailing Address) <br />Lathrop, CA 95330 <br />(City, State, Zip Code) <br />(916)505-8405 <br />(Area Code - Telephone Number) <br />subarron@sefnco.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />Sketch (Detailed plans may be submitted) <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 />5/6/2024 TO 7/6/2024 DRIVEWAYS: <br />Tully Rd <br />QUAD <br />Traffic Control Devices <br />SS/VWV <br />Special Conditions <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 approximately (:) feet/ Q mile <br />of , by performing the following work (description of work): <br />SPLICE AT 2 EXISTING LOCATIONS WITHIN THE COUNTY OF SAN JOAQUIN ROW. <br />Work will commence on or after 5/6/24 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 />SUZETTE BARRON/ Permit Coordinator / SEFNCO 3/13/24 <br />Signature of Applicant - Title Date <br />