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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <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 />deberha rdt@catwater. oom <br />(Email Address) <br />may <br />See attached <br /># 8643 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />TO 12/15/2022 DRIVEWAYS: <br />Mendocino Ave. ' <br />AREA <br />TYPE <br />Stockton QUAD <br />Bell Hole <br />CC ' <br />' <br />FORMS <br />NOTES <br />SSMNV, R-29, TrenchCut <br />Special Conditions <br />Policy— <br />o icyNOTES <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 W Mendocino Ave approximately 32 feeftle East <br />of Franklin Ave , by performing the following work (description of work): <br />2093 W Mendocino Ave <br />Service Repair 763000 <br />Work will commence on or after 1016/2022 for approximately 60 days, <br />I, the undersigned, certify 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 <br />Signature of Applicant - Title <br />r varuSI TM"USomro� r ff uwaMxex ryx) <br />10/6/2022 <br />Date <br />