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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 05/22/25 <br />To: San Joaquin County <br />Department of Public Works <br />Cher Price <br />(Applicant Name) <br />PO Box 59028 <br />(Mailing Address) <br />Norwalk, CA 90652 <br />(City, State, Zip Code) <br />972-325-7886 <br />(Area Code - Telephone Number) <br />CHC-Permitting-6@chcconsulting.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />JOB # JB1428491 <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />REF # <br />CR # <br />TO DRIVEWAYS: <br />QUAD <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 25775 PATTERSON RD. approximately 1519 feet/mile FEET <br />of , , by performing the following work (description of work): <br />To-nv9rl9.ch . <br />of new cable along 1 existing vault and 1 existing nnle on Pattarcnn Pass Rd & International Pkxuy Plana traffir <br />control sianaae within COUNTY OF SAN J0AOUIN Jurisdiction for the work heina performed in CALTRANS <br />Jurisdiction. Place anchor on existina Dole #1. #2. #4 & #5 on Patterson Pass Rd & International Pkwv. <br />Work will commence on or after 07/07/25 <br />for approximately 2 <br />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 />Permitting for Comcast <br />Signature of Applicant - Title <br />Y \FORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATION dos (08/08) <br />05/22/25 <br />Date <br />