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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8574 <br />Date 4/12/2021 <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 />may <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 />4t I 2t202 I TO GM 9�292i DRIVEWAYS: <br />Stu es Ave. <br />QUAD NIS <br />SSANVV, 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 Stokes Ave approximately 1300 feetlmile North <br />of E Fremont St by performing the following work (description of work): <br />1033 Stokes Ave <br />Install 140' of 8" P.VC main & Install new 8" DI fire service WO: 00126122 <br />1 Cut -2'x140' <br />Work will commence on or after 4/12/2021 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 />Y1W SAI PlA�CRUACWMT KWr APRICVMA (WO) <br />4/12/2021 <br />Date <br />