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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8600 <br />Date 1/28/2022 <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@caMater.com <br />(Email Address) <br />plans may be <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 REF If <br />CR # <br />TO DRIVEWAYS: <br />M–Ku—m-gr— <br />-Sloc on QUAD <br />Bell Holes (3) <br />SSNWV, 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 South side of E Stadium Or approximately e9 fsetlmile East <br />of North E St , by performing the following work (description of work): <br />2314 E Stadium Or <br />Install New 1" Service <br />Work will commence on or after 1/28/2022 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.VIXN9l TFIlMTE9FNCRSY.1MFMiF1i11T1}AKAI%Y16� RS91) <br />1/28/2022 <br />Dale <br />