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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 11/29/2022 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant Name) <br />1602 E Lafayette Sl <br />(Mailing Address) <br />Stockton, Ca 95205 <br />(City, State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@cahvater.00m <br />(Email Address) <br />may <br />See attached <br /># 8673 <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />12/5/2022 TO 2/15/2023 DRIVEWAYS: <br />Wallace Ave. <br />AREA <br />TYPE <br />Stockton QUAD <br />Bell Hole <br />CC <br />k <br />FORMS <br />NOTES <br />SS/VWV 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 Wallace Ave approximately 95 feet/mile North <br />of Princeton Ave , by performing the following work (description of work): <br />Cut - 3'x3' <br />Work will commence on or after 11/29/2022 forapproximately 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 11/29/2022 <br />Signature of Applicant - Title Date <br />Y VQ@�S� iB/M1E9&KR0.+LWOrt HR1rtIP0.KATgt6z W on <br />