Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8671 <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 St <br />(Mailing Address) <br />Stockton, Ca 95205 <br />(City, State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@raWater.com <br />(Email Address) <br />may be submitted) <br />See attached <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 />Hazelton Ave. ' <br />AREA <br />TYPE <br />Stockton QUAD WS ' <br />Bell Hole ' <br />FORMS <br />NOTES <br />SS/WVV, 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 North side of W Hazelton Ave approximately 56 feet/mile East <br />of Ventura Ave by performing the following work (description of work): <br />1898 W Hazelton Ave <br />Main Repair 761000 <br />1 Cut -4'x4' <br />Work will commence on or after <br />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 <br />Signature of Applicant- Title <br />rvaase teitut[sarxa�cwwrrrwirunx�nanexµm� <br />11/29/2022 <br />Date <br />