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PLEASE PRINT: <br />Date 11/18/2022 <br />To: San Joaquin County <br />Department of Public Warks <br />California Water Service Company <br />(Applicant Nai <br />1602 E Lafayette St <br />(Mailing 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 />deberhardt@calwateccom <br />(Email Address) <br />may <br />See attached <br /># 8659 <br />JOB# <br />APN <br />EXP. DATE <br />VALID <br />STREETeTRorTe7ave. <br />AREAo� <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF# <br />CR # <br />TO 12023 DRIVEWAYS: <br />QUADVVS ' <br />' <br />rencri Uuto icy <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 Del Norte Ave approximately 205 feet/mile South <br />of W Washington Sl , by performing the following work (description of work): <br />224 Del Norte Ave <br />1" Service Replacement STK0600 <br />2 Cuts - 7'x7' + 3'x3' <br />will commence on or after <br />11/18/2022 <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 />v vows a re�MnstrtcaoxxvElrt ttsrrt �ta,cmwes rsas7 <br />11/18/2022 <br />Date <br />