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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Dale February 26, 2024 <br />To: San Joaquin County <br />Deparlmeot of Public Works <br />Carfornia Water Service Company <br />(Applicant Name) <br />1602 E Lafayette SI <br />Mailing Address) <br />Stockton, CA 95205 <br />(City, State, Zip Cadet <br />209) 2704576 <br />Area Code • Telephone Number) <br />sdncon@calwaleccom <br />(Email Address) <br />Sketch (Detailed plans may be submitled) <br />See etched <br />4K34 <br />JOBq <br />NPN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REFS <br />CRH <br />2920229202 T4'' DRIVEWAYS'. <br />Pershirn Ave ' <br />Stockton QUAD <br />Raise Gate valve <br />SSMAW,R-29, Trench Cut Policy <br />SpecialConditions <br />The undersigned hereby applies for permission to excavate, construct andlorotherwise encroach on County Highway Ro-of•Waycn <br />the North side of Middlefield Avenue approximately 6 feefte West <br />of NPershinoAvenue byperfonningthe following work (dascdpbonofwork)� <br />2201 N Pershing Avenue <br />Raise overlaid mane valve <br />1 CA -3'x3, <br />STKO620 <br />WorkwilcommenceonorafRr_Febmarv26,2024 for approximately ao days. <br />I, the undersgned,cerbfy that I am the owner of the respeclrve properly, or am qualified Ie 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 approvd <br />StephanieRincon, Regional Foreman ofOperations and Maint February 26, 2024 <br />Signature 0 Applicant, This new <br />