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PLEASE PRINT: <br />Date 3/30/2022 <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)464-6311 <br />(Area Code - Telephone Number) <br />deberhardt@catwater.00m <br />(Email Address) <br />may <br />See attached <br /># 6613 <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 />4M �2e22 611512022 <br />TO DRIVEWAYS: <br />bt. ' <br />6tockton QUAD <br />—BerIIToe— ' <br />SS rench Uut Holicy <br />Special Conditions <br />The undersigned hereby applies for permission 10 excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of North F St approximately o feeUmile South <br />of E Alpine Ave by performing the following work (description of work): <br />3250 N Wilson Wav (On North F <br />Work will commence on or after <br />for approximately <br />761000 <br />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 />David Eberhardt Jr - Operations Clerk <br />Signature of Applicant - Title <br />3/30/2022 <br />Date <br />