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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/10/2022 <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) 464-6311 <br />(Area Code - Telephone Number) <br />deberhardt@calwater.com <br />(Email Address) <br />plans may be submitted) <br />See attached <br /># 8597 <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 />1/14/2022 TO 3/15/2022 DRIVEWAYS: <br />B Street ' <br />Stockton QUAD SS <br />Bell Holes (2) ' <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 South B St approximately 146 feet/mile North <br />of E 5th St by performing the following work (description of work): <br />1826 & 1834 South B St <br />Install 2 New 1" <br />2 Cuts - 4'x4' + <br />Work will commence on or after 1/10/2022 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.YIXNl56lFLPIAfr5FNG9QYA44EMPERVIrAWl1Gi10N 0.e�M9I) <br />1/10/2022 <br />Date <br />