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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Dale 1111812022 <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@catwater.com <br />(Email Address) <br />plans may be submitted) <br />See attached <br /># 8658 <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 />12 11202TO DRIVEWAYS: <br />icve. <br />Stockton QUAD CC <br />e o es <br />-SSnrencn Cuto icy <br />bpecial 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 Michigan Ave approximately 245 feeUmile East <br />of Kirk Ave , by performing the following work (description of work): <br />1" Service Replacement STK0600 <br />Work will commence on or after <br />approximately <br />I, the undersigned, certily 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 />YVOb1S6 iEUM1ES➢iCR6YHVEMPEINRAPR1G11GiEs(3 <br />11/18/2022 <br />Date <br />