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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8578 <br />Date 4/22/2021 <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 />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 />4/22/2021 TO 7/1/2021 DRIVEWAYS: <br />Hinkley Ave. <br />Stockton QUAD ES <br />Bell Hole <br />SS/VVVV, 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 West side of SHinkley Ave approximately 536 feet/mile North <br />of Horner Ave by performing the following work (description of work): <br />427 S Hinkley Ave <br />3/4" to 1" Service Upgrade STK0600 <br />Work will commence on or after <br />for approximately <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 <br />Signature of Applicant • Title <br />YVOMIB6TRIPIAIES MOAC111.1ENT PMAIT pPPl1C WN.dm(MM) <br />4/22/2021 <br />Date <br />