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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 01/09/2024 <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 <br />(209)547-7934 <br />(Area Code - Telephone Number) <br />ahenson@calwater.com <br />(Email Address) <br />may <br />See attached <br />#8728 <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 /11 /2024 TO 311112024 DRIVEWAYS: <br />Sinclair Ave ' <br />Stockton QUAD ' <br />Bell Hole ' <br />SS/WW R-29 Trench Cut Policy <br />SPOGial Conditions�— <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the South side of S Sinclair Ave approximately 250 feeUrrile South <br />of E Fourth St , by performing the following work (description of work): <br />763000 <br />Work will commence on or after 01/09/2024 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 01/09/2024 <br />Signature of Applicant - Title Date <br />MW 6 i9APGMMCROACHMEM PEWff APNGiION,tlrc(Ol <br />