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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 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@Galwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br /># 8603 <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 />21112022 TO 41112022 DRIVEWAYS: <br />nkley Ave <br />6tockton QUAD <br />Bell Hole ` <br />SSfVWV, R-29, Trench Cut Policy <br />peaa on ions <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 S Hinkley Ave approximately 83 feet/mile South <br />of Horner Ave by performing the following work (description of work): <br />712 S Hinkley Ave <br />Main Repair 761000 <br />1 Cut -3'x3' <br />commence on or after 1/31/2022 for approximately <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 />YTF WR8TE44VgTUETiM0.kCNlf1RPFRNTRPPLIC9110'lde: F.4u) <br />1/31/2022 <br />Date <br />