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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 06/27/2023 <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 />ejose@calwater.com <br />(Email Address) <br />may <br />See attached <br />#8696 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREETang3 <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />TO DRIVEWAYS: <br />uineti n. " <br />Stockton QUAD NS <br />Bell Holes, Trenched " <br />SS/WW, R-29, Trench Cut Policy, <br />bpecial Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of Sanguinettl Lane approximately 120 feet/mile North <br />of Cherokee Road by performing the following work (description of work): <br />Install 3 New Services - (2) 8" Fire. (1) 2" Domestic <br />Work will commence on or after 06/27/2023 for approximately 60 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 />Evelyn Jose - Field Service Representative <br />Signature of Applicant - Title <br />V:IFOPMS 6TM%AV NCROIHMEM PEWR MFUMG do (WO) <br />06/27/2023 <br />Date <br />