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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/2/24 <br />To: San Joaquin County <br />Department of Public Works <br />ASTOUND BROADBAND (MAKSIM ZHURAVLEV) <br />(Applicant Name) <br />4121 CITRUS AVE <br />(Mailing Address) <br />ROCKLIN, CA 95677 <br />(City, State, Zip Code) <br />425-393-5411 <br />(Area Code - Telephone Number) <br />MAKSI M.ZHURAVLEV@ASTOUND.COM <br />(Email Address) <br />may <br />SEE PLANS <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 ENILE AVE approximately 330 @ feet/ 0mile WEST <br />of UNION RD _ , by performing the following work (description of work): <br />TRENCH OR POTHOLE TO LOCATE EXISTING FACILITIES AND VERIFY CLEARANCE WITH SSJID FACILITIES. <br />Work will commence on or after 2/15/24 for approximately 2 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 />2/2/24 <br />Signature of Applicant - Title <br />Date <br />