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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02-16-2022 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette St <br />(Mailing Address) <br />Stockton, Ca 95205 <br />(City, State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />mrizo@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />OFFICE USE ONL <br />JOB # 730077 REF # <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />tree Below <br />AREA <br />6tockton QUAD 11113 <br />TYPE <br />Trench, Bores, Bell Holes <br />FORMS <br />SSNWV, R-29, Trench Cut Policy <br />NOTES <br />Special Conditions <br />CLOSURES, OPENED TO THROUGH TRAFFI( <br />NIGHTLY. DURING NON -WORKING HOURS <br />5:OOPM***** <br />o;NO()-2-L4GD SIS- Mi&fleiW Av'(?� <br />® 31 Co - PedV ax k'e <br />® 5� pv - 3 PSIk Delved -ere Ave, <br />® <br />2,2A) - 2-11� 61 I- M P i yl'e A\`C- <br />The undersigned hereby applies for permissiop tq excavate construct and/or otherwise encrgac County Highway Right -of -Way on <br />the V 6W (M S side of Si Y7.94.6 Cl6'1Cd (� approximately 6Fr� feet/rMe- <br />of u r rfM Di i�11 -1 by performing the following work (description of work): <br />Work will commence on or after GL 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 />Melissa Rizo MRP Field Operations Clerk 02-16-2022 <br />Signature of Applicant - Title Date <br />rvauns a.Qamn�ss�cnonL�rR vewan awucnnoraea ryema� <br />