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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/4/2022 <br /># 8636 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />TO 2/152023 DRIVEWAYS: <br />Myran Ave. & Florida v- <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette St <br />AREA <br />TYPE <br />Stockton QUAD <br />mole <br />(Mailing Address) <br />Stockton, Ca 95205 <br />FORMS <br />NOTES <br />SSMNy, R-29, Trench Cut Policy <br />Special Conditions <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 />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 Myran Ave approximately 16 teetlmile South <br />of Florida Ave , by performing the following work (description of work): <br />2820 / 2828 Florida Ave & 2003 / 2015 Myran Ave <br />Install 155' of New 4" PVC Main & 2 New 1" Services + 3/4" to 1" Service Upgrade (2820 Florida Ave) <br />2'x160' (Myran Ave) + 4'x4' & 2'x2' (2820 Florida Ave) <br />Work will commence on or after <br />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 />T:AMMS&iFM% nh 04CROXHMFM PEWIT P}} =ONdoc MS) <br />10/4/2022 <br />Date <br />