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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date February 26, 2024 <br />To San Joaquin County <br />Depadmeotof PubllcWorts <br />California Water Samoa Company <br />(Applicant Name) <br />1602 E Lafayette St <br />jMalling Address] <br />Stockton, CA 95205 <br />(City, Steel, Zip Code) <br />(209) 279.4576 <br />)Area Cade • Telephone Number] <br />sdncon@caWater.com <br />)EmailAddress) <br />Sketch (Detailed clams may be submitted) <br />See attached <br />#6736 <br />JOB# <br />APN <br />EXR GATE <br />VALID <br />STREET <br />AREA <br />TYPEais� <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF <br />CR# <br />212942 i 4/29/2024 <br />TO DRIVEWAYS' <br />Funston Ave, <br />ORAD <br />e ,f ate value <br />pecia on mons <br />The undersigned hereby applies for permiss Ion to excavate, corstmolandlor otherwise encroach on County Highway Rig hi-0f-Wayon <br />the South side of NFunstonAvon ue approximately 37 feebmile East <br />of WebbStreet by performing the following work(description of0�: <br />2102 N Funslan Avenue <br />1 cut -3' z3' <br />STN0620 <br />Workwillcommence onorafter February 26, 2024 forapproamately eo days. <br />I, the undersigned, ceo tat I am the war the respective property, or am qualified to represent the owner and agree to do the <br />work dill above In accordance with the rules and regulations of San Joaquin County and subject to inspection at approval. <br />Stephanie Rincon, Regional Foremen of Operations and Maint. Febmary26,2024 <br />Signature of Applicant - Tile Date <br />nfgK11EMWR8aIFU:�IFI�iEiMf MVd�gIk�WRI <br />