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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: #8729 <br />Data February 26, 2024 <br />To: San Joaquin County <br />Department of PuNlcWorks <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette St <br />iMailingAddress) <br />StocMton, CA 95205 <br />(CI ,State,2lpCode) <br />(209) 2794576 <br />(Area Code • Telephone Number) <br />srincon@calwateccwm <br />(Email Address) <br />Sea attached <br />JOB# <br />APN <br />EXP, DATE <br />VAUD <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF# <br />CRO <br />272902n T—�4 DRIVEWAYS: <br />Mlnerke <br />QUAD <br />Rai se Manhole, Release Valve&Bio&off <br />SM, Trench cut Policy <br />Serial conditions <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right•obWayon <br />the North side of E. Miner Avenue approximately 183 feetimile East <br />of N. Broadway Avenue,byperforming the following work (description ofwork): <br />STKO520 <br />Work Oil commenceonora%r February 26, 2024 forappmxlnntely 0o days, <br />I, the undersigned, call that I am the owner of the respective properly, Cram quail%ed to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin Coumyand subject to'mspecdonand approval. <br />Stephanie Rincon, Regional Foremen of Operations and Maint. February 26, 2024 <br />Signature of Applicant• Tits Date <br />yM11wartxXxa HWVPFWARYWumgq <br />