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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10112/2022 <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@caKyater.com <br />(Email Address) <br />may be submitted) <br />See attached <br /># 8650 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF # <br />CRN <br />11/10/2022 TO 1/15/2023 DRIVEWAYS: <br />oxford way ' <br />Stockton QUAD CC ' <br />Bell Holes ' <br />SSNWV, R-29, R-5, R-6, 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 Oxford Way approximately 10 feeumile West <br />of Grange Ave by performing the following work (description of work): <br />1705 Oxford Way (2627 Grange Ave) <br />New 1" Service Install STKO600 <br />1 Cut -4'x4' <br />Work will commence on or after 10/12/2022 for approximately 60 days. <br />I, the undersigned, cedify 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 />YVOId156 TEVMIES�PFf0.HtIRiKAINkIhe PdOBj <br />10/12/2022 <br />Date <br />