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PLEASE PRINT: <br />Date 07/21/2023 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1002 E Lafayette St <br />(Mailing Address) <br />Stockton, Ca 95205 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(209)547-7934 <br />(Area Code - Telephone Number) <br />ahenson@calwater.00m <br />(Email Address) <br />may <br />See attached <br />#8702 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMSbb/vvvv,rent <br />NOTES <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />7/28/2023 TO 912812023 DRIVEWAYS: <br />in s�O dor Ave: ' <br />QUAD ES' <br />Bell Hole « <br />u oIcy <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the South side of NWindsor Ave approximately 23 feet(mile East <br />Of Osbom Ave , by performing the following work (description of work): <br />Install new 1" Service <br />Work will commence on or after 07/21/2023 for approximately <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 />Antoinette Henson - Field Service Representative <br />Signature of Applicant - Title <br />YAMMS{iBA0.AM MMi MEM PEWIT MPMGMd= PPO) <br />07/21/2023 <br />Date <br />