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APPLICATION FOR ENCROACHMENT PERMIT # 8566 <br />PLEASE PRINT: <br />Date 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 />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 />3/30/2021 TO DRIVEWAYS: <br />WilloW St. <br />Stockton QUAD NS <br />SS/V VV 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 North side of E Willow St approximately 139 feet/mile '/vest <br />of North E St , by performing the following work (description of work): <br />New 1" Service Install STK0600 <br />1 Cut - 4'x4' <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 />Y:WWAS& 1@1PIAlE5L41CR C4 NT 9 ANlIC4TW.d¢ PM) <br />3/30/2021 <br />Date <br />