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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 01/03/2024 <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 />plans may be submitted) <br />See attached <br />#8721 <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 />1/5/2024 TO 3/5/2024 DRIVEWAYS: <br />Sonoma Ave <br />Stockton QUAD <br />Bell Hole <br />SS/WW R-29, Trench Cut Policy <br />F—: <br />-- <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North side of W Sonoma Ave approximately 15 feet/mile East <br />of Moon Ave , by performing the following work (description of work): <br />3535 W Sonoma Ave <br />Work will commence on or after <br />01/03/2024 <br />for approximately <br />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 <br />Signature of Applicant - Title <br />Y MMS <br />01/03/2024 <br />Date <br />