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PLEASE PRINT: <br />Date 03/07/2024 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette St <br />(Mailing Address) <br />Stockton, CA 95205 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(209) 547-7934 <br />(Area Code - Telephone Number) <br />ahenson@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />#8739 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 <br />REF # <br />CR # <br />3/9/2024 TO 5/9/2024 DRIVEWAYS: <br />Sinclair Ave. <br />Stockton QUAD <br />Bell Hole <br />SS/VWV, R-29, Trench Cut Policy <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the South side of S Sinclair Ave approximately 5 feet/mile South <br />of Horner Ave by performing the following work (description of work): <br />Main Valve Replacement <br />1 Cut - 3'X5' <br />Work will commence on or after 03/07/2024 for approximately 60 days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to 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 approval. <br />Antoinette Henson - Field Service Representative 03/07/2024 <br />Signature of Applicant - Title Date <br />YIFORMS 6 TEMPLATESIENCROACHMENT PERMIT APPLICAMON.Ax (08 08) <br />