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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <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 />d ebe rha rd t@calwateccom <br />(Email Address) <br />may be submitted) <br />See attached <br /># 8644 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />10/7/2022 Tp DRIVEWAYS: <br />Webster Ave. <br />AREA <br />TYPE <br />Stockton QUAD CC <br />-BeTFR—ole— ' <br />FORMS <br />NOTES <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 East side of Webster Ave approximately 75 feeUmile North <br />of Inman Ave , by performing the following work (description of work): <br />Webster <br />Main Repair 761000 <br />Work will commence on or after <br />for approximately 60 <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 />10/6/2022 <br />Signature of Applicant - Title Date <br />Y:YIXA156TELMIESEIiL5A�L1YINf PFFIR /PVGTIXIdz 1�d1 <br />