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APPLICATION FOR ENCROACHMEN T PERMI T <br />PLEASE PRINT: # 8657 <br />Date 10/24/2022 <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@Galwater.com <br />(Email Address) <br />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 />10/27/2022 TO 1/1/2023 DRIVEWAYS: <br />Colles ' <br />Stockton QUAD NS <br />--g–eff Tlole— ' <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 College Ave approximately 26 feel/mile West <br />of Berkeley Ave , by performing the following work (description of work): <br />Service Repair <br />1 Cut - 2'x2' <br />Work will commence on or after 10/24/2022 for approximately so 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 />Y VQ4l5d TFkM1ES9:CRO%1ILf]RPFIdJR/Ri1G11IXihc RBW) <br />10/24/2022 <br />Date <br />