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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <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 />plans may be <br />See attached <br />#8716 <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 />Stockton QUAD ' <br />Jersey St. " <br />SS/WW, R-29, Trench Cut 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 North side of Jersey St approximately 222 feet/mile West <br />of Sanouinettl Ln by performing the following work (description of work): <br />Main Repairs <br />1 Cut -4'X11' <br />761000 <br />Work will commence on or after 01/08/2024 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:.nWIBB i9ARAlESENMWHMWPERMR/30.MON.A.PMB) <br />