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PLEASE PRINT: <br />Date 1011212022 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette St <br />(Malting Address) <br />Stockton, Ca 95205 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />d eberh and t@calwater.00m <br />(Email Address) <br />may <br />See attached <br /># 8648 <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 />11/10/2022 TO 1/15/2023 DRIVEWAYS: <br />Los Angeles Ave. ` <br />Stockton QUAD ws ' <br />Bell Hole ' <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 S Los Angeles Ave approximately 203 feet/mile North <br />of w Hazelton Ave , by performing the following work (description of work): <br />512 S Los Angeles <br />New 1" Service Install STK0600 <br />1 Cut -4'x4' <br />commence on or after <br />for approximately <br />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 />Y, a $ATWll WSfN(FOALINfM GFAJR/AVG1KKlfe <br />10/12/2022 <br />Date <br />