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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8602 <br />Dale 1/31/2022 <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@catwater.com <br />(Email Address) <br />may <br />See attached <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 />TO <br />Country Club Blvd. <br />Stockton QUAD CC <br />Trench <br />- <br />Special Conditions <br />DRIVEWAYS: <br />" <br />" <br />rench Cut oicy <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North side of Country Club Blvd approximately 45 ftletlmile Fest <br />of N Pershing Ave , by performing the following work (description of work): <br />1403 Country Club Blvd <br />Meter Box Replacement 5 1 rcunuu <br />1 Cut- 4'x10' (Concrete -Sidewalk) <br />Work will commence on or after 113112022 for approximately 60 days. <br />I, the undersigned, certify that I am the owner of the respective properly, 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 1/31/2022 <br />Signature of Applicant - Title Date <br />YYOR196 fEUM1E5FNCA]1CINFHIPFA.4IMP1CAiMNEx p141� <br />