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APPLICATION FOR ENCROACHMENT PERMIT <br />19��_F'3�d:tI�YIF <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 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 />#8724 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FARMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />1/11/2024 TO 3/11/2024 DRIVEWAYS: <br />Lillian Ave. <br />Stockton QUAD <br />(2) - Bell Holes ' <br />SS/AUAh7 R-29, Trench (timet PolicyPolicy <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 N Lillian Ave approximately 150 feet/mile North <br />Of E Miner Ave , by performing the following work (description of work): <br />2 Cuts - 3'X3' + 3'X3' <br />Work will commence on or after <br />01/09/2024 <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 01/09/2024 <br />Signature of Applicant - Title Date <br />YIFORA188iEMPUIEMMOXHM PEPMRIPPLIG00HA¢(0808) <br />