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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Dale February 26, 2024 <br />To: San Joaquin County <br />Dapadment of Public Wolks <br />Call Water Service Company <br />(Applicant Name) <br />1602 E Lefayatla $t <br />(MailingAddress) <br />Stockton, CA 95205 <br />(City, State, Zip Code) <br />(209) 279.4576 <br />(Area Code • Telephone Number) <br />srinoon@calwateccorn <br />(Email Address) <br />Sketch (Detailed plans may besubmittedj <br />See awed <br />#8731 <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREAtoc <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF# <br />CR# <br />2129120242/2912024 To DRIVEWAYS: <br />Princeton Ave <br />tone " <br />false Ga 7777 <br />SSIVVW, R-29, Trench Cut Policy <br />Special Conditions <br />The undersigned hereby applies for permission to eccavate,construct andlorothenvise encroach on Courcy Highway Righ4of•Wayon <br />the North side Princeton Avenue approximi 11 fel West <br />of Delano Avenue hyperforming tofollowing ark jdescdplionofwalk), <br />2765 & 2807 Princeton Avenue <br />Raise overlaid pate valves (2) <br />2cuts �3'x3' <br />STKO520 <br />Work will commence on or offer February 262024 for approximately 6o days, <br />I, the undersigned, cedify[hat I am the ownerofthe respedi property, oram qualified to represent the owner and agree to do the <br />work described above in aoitrda9cewith the rules and regulators of San Joaquin County and subject to'mspectlon and approval, <br />Stephanie Rini Regional Foreman of Operations and Maim, February 26, 2624 <br />Signature of Applicant • Title Date <br />r'IWYBIIEYMImF4t�AV"a',I1PNYaNEY:annN�.',ea, <br />