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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8640 <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 />(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 />10/7/2022 TO 12/15/2022 DRIVEWAYS: <br />Kenyon St. + <br />Stockton QUAD NS + <br />Bell Holes + <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 North side of Kenyon St approximately 24 feeUmile East <br />of Sutro Ave , by performing the following work (description of work): <br />3040 Kenyon St (On Sutro Ave) R 3103 Kenyon St <br />Replace 6" Gate Valve R Raise 1 Gate Valve to Grade STK0540 <br />2 Cuts - 4'x4' + 21x2' <br />Work will commence on or after 10/6/2022 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 10/6/2022 <br />Signature of Applicant - Title Date <br />YV s6 Tm"nse�P ff llNG11KK{dzrANI <br />