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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To:San Joaquin County JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code -Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on ounty ighway ght-of-ay on <br />the ______________ side of ___________________________________ approximately ____________ feet/ mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant -Title Date <br />Comcast/SEFNCO Communications <br />12687 S Manthey Rd <br />Lathrop, CA 95330 <br />209-319-3104 <br />sysaelee@sefnco.com / adtrevino@sefnco.com <br />See attached. <br />5/1/2024 <br />east 99 Frontage Rd 116'south <br />Carpenter Rd <br />Access 2 existing poles to perform splicing and service to 3550 99 Frontage Rd for Comcast services. <br />5/27/2024 1 <br />Permit Supervisor 5/1/2024