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PLEASE PRINT: <br />Date 10/23/2023 <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 />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(209)547-7934 <br />(Area Code - Telephone Number) <br />ahenson@calwater.com <br />(Email Address) <br />may <br />See attached <br />#8719 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />730077 <br />1/10/2024 <br />Tallahatchy <br />OFFICE USE ONLY <br />REF # <br />CR # <br />TO 3/10/2024 DRIVEWAYS: <br />Dr." <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />Stockton QUAD ES " <br />Bell Hole <br />SS/WW, R-29, Trench Cut Policy <br />Specia Conditions <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 Tallahatchey Or approximately 71 feet/mile East <br />Of Ozark Ct , by performing the following work (description of work): <br />1" Service Replacement <br />1 -Cut 2'X4' <br />STK0600 <br />Work will commence on or after 10/23/2023 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 <br />Signature of Applicant - Title <br />Y:TOR S&6 PLAIE CRDA HMMTP WITAPPMCATIONE (M" <br />10/23/2023 <br />Date <br />