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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Dale 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 />(City, State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@ralwater.com <br />(Email Address) <br />(Detailed plans may be submitted) <br />See attached <br /># 8610 <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 />4/1/2022 TO 6/15/2022 DRIVEWAYS: <br />Fairmont Ave. <br />Stockton QUAD WS <br />Bell Hole ' <br />SSMNV, 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 East side of Fairmont Ave approximately San feellmile South <br />Of W Ivy St by performing the following work (description of work): <br />3238 Fairmont Ave <br />V Service Replacement STKO600 <br />1 Cut -3'x7' <br />Work will commence on or after 4/1/2022 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 />David Eberhardt Jr - Operations Clerk <br />Signature of Applicant - Title <br />rvoAesa tfunitcsan �twn uxiuirovwc 7.a ua� <br />3/30/2022 <br />Date <br />