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PLEASE PRINT: <br />Date <br />11/21/2022 <br />APPLICATION FOR ENCROACHMENT PERMIT <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@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br /># 8663 <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 />11/28/2022 TO 2/1/2023 DRIVEWAYS: <br />Kirk Ave. ` <br />Stockton QUAD CC ` <br />Bell Hole ` <br />SSANVV R-29 Trench Cut Poliov <br />Special Condition <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 Kirk Ave approximately o feeUmile North <br />of Inman Ave , by performing the following work (description of work): <br />v919 rent. eva <br />Main <br />1 Cut - 3'x3' <br />Work will commence on or after 11/21/2022 for approximately 60 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 11/21/2022 <br />Signature of Applicant - Title Date <br />Y.q $ 11FLMIEBF),CANLIYFM PFAI?MftMAMN d P" <br />