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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/15/2023 <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)547-7934 <br />(Area Code - Telephone Number) <br />ahenson@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />#8720 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />12/15/2023 TO 2n si2n24 DRIVEWAYS: <br />Taft Ave & Marshall Ave. <br />AREA <br />TYPE <br />Stockton QUAD WS <br />(1) - Bell Holes <br />FORMS <br />NOTES <br />SSAVW R-29, Trench ('T�t 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 East side of Taft Ave approximately 65 feetlmile West <br />of Marshall Ave , by performing the following work (description of work): <br />928, 039; 93444*6-Taft-Av" 1787 Marshall Ave ***Taft Ave. is within the City ot Stockton Juns iction <br />(4) 1" Service Installs & (1) 3/4" Service Abandonment <br />a r. W (o) ewo" ., im 8941 • 3,x3, <br />STK0600 <br />Work will commence on or after 12/15/2023 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 />Antoinette Henson - Field Service Representative 12/15/2023 <br />Signature of Applicant - Title Date <br />VIFOSMS 0 TBSPI SIENORO WWT PBBMRAPP WIMN "M0) <br />