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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date February 26, 2024 <br />To: San Joaquin County <br />Department of Public Works <br />California Water SONIO) Company <br />Applicant Name) <br />1602 E Lafayeae St <br />iMailingAddress) <br />Stockton, CA 95205 <br />(C ,,State,2ipCodel <br />(209) 279-0676 <br />(Area Code Telephone Number) <br />srincon@calwater.com <br />(EmailAddreas) <br />Sea attached <br />#8730 <br />JOB <br />AFN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />REF# <br />CR# <br />vmza TO' DRIVEWAYS: <br />MchgenA* <br />QUAD <br />Ram Gate vak <br />ssmw,Rza,rlemhCuRg <br />Srysiel Undibns <br />The undersigned hereby applies for permission to excavate, construct andlorotberwise encroach on County Highway Rlghtion <br />the South sideof Michigan Avenue approximately 34 leellmile west <br />of Marne Avenue by performing the following work (desorption ofworki' <br />20322�gan Avenue <br />Raise overlaid gate valve <br />STKO520 <br />Wotwill commerce onorafter _FebruarY26.2024 forapproxlmatey 6F days. <br />I, the undersigned , cedifythat I am the over of the respective property, or am quallfed to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin Countyand subject to Inspection and approval <br />Stephanie Rincon, Regional Foreman of Operations and Maint <br />Signalura of Applicant • Title <br />Y?PoSUIl:V0.oRYEMAI'CW:11V@u14VR1:11i0uaaPoby <br />February 26, 2024 <br />Date <br />