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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1131/2022 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette Sl <br />(Mailing Address) <br />Stockton, Ca 95205 <br />(City, State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@calwater.com <br />(Email Address) <br />(Detailed plans may be <br />See attached <br /># 8601 <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 />2/8/2022 TQ 4/15/2022 DRIVEWAYS: <br />Piccoli Rd. ' <br />Stockton QUAD NS ' <br />Bell Holes (3) <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 Piccoll Rd approximately 107 feeVmile south <br />of E Waterloo Rd by performing the following work (description of work): <br />4170 E Waterloo Rd (On Piccoli <br />Install New 1" Service <br />2 Cuts - 2'x2' each (Street -Asphalt) + 1 Cut 4'x4' (Back of Walk -Dirt) <br />Work will commence on or after 1/31/2022 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 />Y.V IXa\IS 61EV M1ESfM:ftOMTYFM FFRIR /RLG1gN tla �+�i <br />1/31/2022 <br />Date <br />