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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8573 <br />Date 4/1/2021 <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 <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 />4/2/2021 TO 7/1/2021 DRIVEWAYS: <br />Odell Ave. <br />Stockton QUAD WS <br />(2) - Bell Holes <br />SS/WW 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 Odell Ave approximately 303 feet/mile Soith <br />of Clayton Ave . by performing the following work (description of work): <br />3740 Odell Ave <br />3/4" to 1" Service UI <br />2 Cuts - 4'x4' + 2'x2' <br />commence on or <br />for approximately <br />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 4/1/2021 <br />Signature of Applicant -Title Date <br />YY a TBa%AT6YNgIQ1CNMa1T Pa ff APP407IMft(Lem) <br />