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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8563 <br />Date <br />3/9/2021 <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 submitted) <br />See attached <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 Redwood Ave approximately S1 feettmile East <br />of E Alpine Ave by performing the following work (description of work): <br />Ave <br />Main Repair <br />1 Cut -3'x10' <br />Work will commence on or after .3 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 />T. MsaI PUIESQICRM mw Kwr PPrLWlT O (� <br />3/9/2021 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730077 REF # <br />APN <br />CR # <br />EXP. DATE <br />, srssnml <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />�dwoo-dWve. <br />pis <br />AREA <br />— QUAD <br />TYPE <br />FORMS <br />oicy <br />NOTES <br />Special on ions <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 Redwood Ave approximately S1 feettmile East <br />of E Alpine Ave by performing the following work (description of work): <br />Ave <br />Main Repair <br />1 Cut -3'x10' <br />Work will commence on or after .3 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 />T. MsaI PUIESQICRM mw Kwr PPrLWlT O (� <br />3/9/2021 <br />Date <br />