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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 6569 <br />Date <br />3/30/2021 <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)464-6311 <br />(Area Code - Telephone Number) <br />deberhardt@calwater.com <br />(Email Address) <br />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 />3/30/2021 TO 6/15/2021 DRIVEWAYS: <br />Euclid Ave. <br />Stockton QUAD CC <br />Bell Hole <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 South side of W Euclid Ave approximately 145 feet/mile Fest <br />Of Wisconsin Ave by performing the following work (description of work): <br />W Euclid Ave <br />2 -1" Service <br />1 Cut -4'xT <br />Work will commence on or after 3/30/2021 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 />YWWS&i PIAiESB10iW MT PEW APPuf MAX(M) <br />3/30/2021 <br />Date <br />