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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 6637 <br />Date 10/5/2022 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette St <br />Stockton, Ca 95205 <br />Address) <br />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 <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 />10/7/2022 TO 12/15/2022 DRIVEWAYS: <br />Roselawn Ave. <br />Stockton QUAD CC <br />Bell Holes <br />SSW 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 North side of Roselawn Ave approximately 10 feet/mile East <br />of Mission Rd , by performing the following work (description of work): <br />1876 Country Club (On Roselawn Ave) & 2307 Buena Vista Ave (On Roselawn Ave) <br />Replace 6" Gate Valve & Raise 1 Gate Valve to Grade STKO540 <br />Work will commence on or after 10/5/2022 for approximately <br />mm <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 />v�raass rwanrzs�aatwauwrc�wnuwuncxemReal <br />10/5/2022 <br />Date <br />