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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 9/6/2023 <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 />ilima@calwater.com <br />(Email Address) <br />may <br />See attached <br />#8711 <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 />9/11/2023 TO 11/11/2023 DRIVEWAYS: <br />Delano Ave. <br />Stockton QUAD CC <br />(3y--D—eFHo1es <br />rench UutPolicy <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 3500 Delano Ave approximately 5 feet/mile North/South <br />of Inman Ave and Telegraph Ave by performing the following work (description of work): <br />Asphalt Restoration of Gate Valve Covers <br />3 Cuts -1'x1'. 1'x1'. 1'x1' <br />Work will commence on or after 9/6/2023 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 />Jared Lima - Operations Clerk <br />Signature of Applicant • Title <br />Y YORVS 6 iEYM1E5&tigS!'d.NYFIR PFA4R P3flKA1N)'I bx (0896 <br />9/6/2023 <br />Date <br />