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PLEASE PRINT: <br />Date 08/30/2023 <br />To: San Joaquin County <br />Department of Public Works <br />Califomia Water Service Company <br />(Applicant Name) <br />1602 E Lafayette St <br />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 />ahanson@caiwater.com <br />(Email Address) <br />may <br />See attached <br />tfR705 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />9/20/2023 TO DRIVEWAYS: <br />Odell Ave. <br />Stockton QUAD WS + <br />Bell Hole <br />SSMNV, R-29, Trench Cut POlicy <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 North side of Odell Ave approximately 100 feet/mile South <br />Of Horton Ave , by performing the following work (description of work): <br />1" Service R <br />1 Cut - 2'X2' <br />STK0600 <br />Work will commence on or after 08/30/2023 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 />Antoinette Henson - Field Service Representative 08/30/2023 <br />Signature of Applicant - Title Date <br />Y.OR I TBARA7MCROMHMEM PEWMAPRI[ATWM (0 ) <br />