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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/1/2021 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant <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 />debemardt@calwater.com <br />(Email Address) <br />(Detailed plans may be submitted) <br />See attached <br /># 8572 <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 />4/1/2021 TO 7/1/2021 DRIVEWAYS: <br />Beatrice Ave. <br />Stockton QUAD NS <br />Bell Hole <br />SS/WVV, R-29,Trench Cut Policy <br />Sppr Al (-.nnci tons <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 Beatrice Ave approximately 68 feettmile south <br />of E Roosevelt St , by performing the following work (description of work): <br />1780 E Roosevelt St (On Beatrice Ave) <br />Service Repair 763000 <br />Will commence on or after <br />4/1/2021 <br />approximately 60 <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 />Y:� &TB.IRAlE51F MC CHM PMff APF(IC9TI d%"=) <br />4/1/2021 <br />Date <br />