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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 91712023 <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 />llima@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />#8713 <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 />TO DRIVEWAYS: <br />arcs Sl— <br />Stockton QUAD ES <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 South side of 5514 E Marsh St approximately 460 feet/mile East <br />Of S Cardinal Ave by performing the following work (description of work): <br />Restoration due to service repair <br />Work will commence on or after <br />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 />Jared Lima - Operations Clerk <br />9/7/2023 <br />Signature of Applicant - Title Date <br />YifQZl4' 6l@IPIAIES&FIL1ibllklR PEAIAR NRSAINrtI Ax j�Y96i <br />