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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8598 <br />Dale 1/11/2022 <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@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <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 # <br />CR # <br />1/11/2022 TO 3/15/2022 DRIVEWAYS: <br />Mourfield Ave. <br />Stockton QUAD WS ' <br />Bell Holes (2) <br />SSf WV, 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 West side of Mourliield Ave approximately 1225 feettmile South <br />Of Clayton Ave , by performing the following work (description of work): <br />New 1" Service Install STKO600 <br />2 Cuts - 4x4'+ 2'x2' <br />Work will commence on or after 1/11/2022 for approximately 60 days. <br />I, the undersigned, certily 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 1/11/2022 <br />Signature of Applicant - Title Di <br />Y.P S6 TEI/ aSENLROAlY6FM PEFMTAfflIG ft@xm) <br />