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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date �J >- <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 <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />(�t Ca( wa.# <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />9/8/2023 TO DRIVEWAYS: <br />Wilson Way <br />AREA <br />TYPE <br />Stockton QUAD NS <br />Traffic Control Devices <br />FORMS <br />NOTES <br />SSMNV <br />Special Conditions <br />****NO Road Closures within County Jurisdiction**** <br />See attached <br />C f12 OA <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the side of approximately feet/mile <br />of by performing the following work (description of work): <br />Work will commence on or after &r - <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 />Signat re of Applicant - Title Dat' e <br />YAFORMS B TEMPLAT MNMGA PERMRRPPLIWIOKd (WMB) <br />