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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 07/06/2023 <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 />(Detailed plans may be submitted) <br />See attached <br />#8697 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />7/13/2023 TO 911312023DRIVEWAYS: <br />Odell Ave. <br />AREA <br />TYPE <br />Stockton QUAD WS <br />Bell Hole <br />FORMS <br />NOTES <br />SAIVW 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 West side of Odell Ave approximately 1635 feet/mile North <br />of Downing Ave by performing the following work (description of work): <br />3327 Odell Ave <br />Install New 1" Service <br />1 cut- 3'x3' <br />commence on or after. 07/06/2023 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 />Evelyn Jose - Field Service Representative <br />Signature of Applicant - Title <br />YtFONM56TEMPLFlE4�£NCROACHMEM PE0.MITPPPLIC MNA. Pffl) <br />07/06/2023 <br />