Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 09/14/2023 <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 />State, Zip Code) <br />(209)547-7934 <br />(Area Code - Telephone Number) <br />ahenson@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be <br />See attached <br />#8701 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREETuc�T7Vv-e— <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />TO DRIVEWAYS: <br />AREA <br />TYPE <br />Stockton QUAD + <br />e o es + <br />FORMS <br />NOTES <br />SS rench CutPolicy <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 East side of E Euclid Ave approximately 33 feet/mile East <br />of N E St , by performing the following work (description of work): <br />3/4" service with <br />2 Cuts - 2X2'+ <br />commence an or atter. 09/14/2023 for approximately <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 09/14/2023 <br />Signature of Applicant - Title Date <br />VUOr0.13 � TFM"IAiESENC MHMW PEMR�GilNM 1M) <br />