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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 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 />plans may be <br />See attached <br /># 8562 <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 />3/9/2021 TO DRIVEWAYS: <br />Guernsey Ave. <br />Stockton QUAD ES <br />Bell Holes (3) <br />SSMNV, 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 Guernsey Ave approximately 77 feet/mile West <br />of S Hinkley Ave , by performing the following work (description of work): <br />3838 Guernsey Ave <br />t" Service Replacement STK0600 <br />3 Cuts - 5'x7' + 5'x7' + 6x5' <br />Work will commence on or after <br />for approximately <br />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�S ATWPIATESelCAOM* MT PERM AWLICAJM.w([fltl8) <br />3/9/2021 <br />Date <br />