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APPLICATION FOR ENCROACHMENT PERMT <br />Date February 26, 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 />(City, State, Zip Code) <br />(209) 279-4576 <br />(Area Code - Telephone Number) <br />srincon@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />##8738 <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 REF # <br />CR# <br />3/9/2024 TO 5/9/2024 DRIVEWAYS: <br />Gilchrist Ave. <br />Stockton QUAD <br />Raise Gate valve <br />SS/WW, 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 West side of Gilchrist Avenue approximately 9 feet/mile South <br />of Lewis Street , by performing the following work (description of work): <br />1647 Gilchrist Avenue <br />Raise overlaid gate valve <br />1 cut -3'x3' <br />STK0520 <br />Work will commence on or after March 9, 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 />Stephanie Rincon, Regional Foreman of Operations and Maint. February 2.6, 2024 <br />Signature of Applicant - Title Date <br />Y:\FORMS & TEMPLATESIENCROACHMENT PERMIT APPLICAT10N.doo (08/08) <br />