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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 01/08/2024 <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 />Sketch (Detailed plans may be submitted) <br />See attached <br />#8722 <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 />TO 3/10/2024 DRIVEWAYS: <br />Jersey St <br />-St—o'cTaton QUAD <br />Bete <br />SS , R-29, Trench Cut Policy <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 E Jersey St approximately 10 feeUmile West <br />Of N Funston Ave by performing the following work (description of work): <br />2304 N Funston Ave <br />1 Cut - 3'X4' <br />761000 <br />Work will commence on or after 01/06/2024 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 01/08/2024 <br />Signature of Applicant - Title Date <br />Y:MORMR 6 TEMPIAMMCRCACHMEM PERMT.NPUCATIMJ. 0M) <br />