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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 06/30/23 <br />To: San Joaquin County <br />Department of Public Works <br />Huynh Nguyen for Comcast <br />(Applicant Name) <br />903 Calle Amanecer, Ste 310 <br />(Mailing Address) <br />San Clemente, CA 92673 <br />(City, State, Zip Code) <br />949-259-5203 <br />(Area Code - Telephone Number) <br />CHC-NodeSegPermit-3@chcconsuIting.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 South side of 599 E 11th St, Tracy, CA approximately 15 feet/mile East <br />of Centerline of N MacArthur or , by performing the following work (description of work): <br />To place traffic control signage within county of San Joaquin jurisdiction for the work being <br />performed in city of Tracy Jurisdiction. (TRA-JB913794-CO) <br />Work will commence on or after 08/09/23 —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 />7 ' X Permitting for Comcast <br />1 S re o Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />06/30/23 <br />Date <br />