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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT; # 8639 <br />Date 10/6/2022 <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 />State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@catwater.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 />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />10/7/2022 TO 12/15/2022 DRIVEWAYS: <br />Netherton Ave. <br />AREA <br />TYPE <br />Stockton QUAD <br />Bell Hole ' <br />FORMS <br />NOTES <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 West side of Netherton Ave approximately o feet/mile North <br />of Guernsey Ave by performing the following work (description of work): <br />1169 Netherton Ave <br />Replace 8" Gate Valve STKO540 <br />1 Cut - 4'x4' <br />Work will commence on or after <br />for approximately <br />Lul <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.Y s TFHflA1E9dTR0.'LM'FM PEfdIRMRIG1kX1Erc FA cad <br />10/6/2022 <br />Date <br />