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APPLICATION FOR ENCRCACI IMEN T PERMIT <br />PLEASE PRINT: <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 />d eberha rd t@calwaler.eom <br />(Email Address) <br />Sketch (Detailed plans may be <br />See attached <br /># 8667 <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 />12/12/2022 TO 2TT5T2023 DRIVEWAYS: <br />icc ae Ave. ' <br />8tockton QUAD SS <br />-B—eFFFoe— ' <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 South side of Michael ave approximately 48 feet/mlle East <br />of South B St , by performing the following work (description of work): <br />3008 South B St (On Michael <br />1" Service Replacement STKO600 <br />2 Cuts - 6'x6' + 4'x12' <br />Work will commence on or after 11/29/2022 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 <br />Signature of Applicant - Title <br />r YUols6 TtvrulFSDrcra Off F£MRItRIG1 ftr" <br />11/29/2022 <br />