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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 08/07/2025 <br />To: San Joaquin County <br />Department of Public Works <br />Astound/Wave Broadband <br />(Applicant Name) <br />4120 Citrus Ave <br />(Mailing Address) <br />Rocklin, CA 95677 <br />(City, State, Zip Code) <br />916-259-6845 <br />(Area Code - Telephone Number) <br />vyacheslay.lobkov@astound.com <br />(Email Address) <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 />Sketch (Detailed plans may be submitted) <br />Set-up traffic control to access and work on existing utility poles. No underground work. 1-2 days of work. <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 O feet/ O mile <br />of by performing the following work (description of work): <br />Work will commence on or after ASAP for approximately 1-2 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 />Permit Coordinator 08/07/2025 <br />Q Signature of Applicant - Title Date <br />