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PLEASE PRINT: <br />Date 3/9/2021 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />1602 E Lafayette St <br />(Mailing <br />Stockton, Ca 95205 <br />(City, State, <br />(209)464-8311 <br />(Area Code -" <br />deberhardt@calwater.com <br />Address) <br />Sketch (Detailed plans may be <br />See attached <br />The undersigned hereby applies for <br />the West side of l' <br />of E Miner Ave <br />APPLICATION FOR ENCROACHMENT PERMIT <br /># 6561 <br />ermission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way h on <br />Shasta Ave approximately 502 feet/mile <br />by performing the following work (description of work): <br />437 N Shasta Ave STKO600 <br />1" Service Replacement <br />2 Cuts - 6'x7' + 3'x6' <br />Work will commence on or after 3/9/2021 for approximately so days. <br />I, the undersigned, certify that I am the finer of the respective property, or am qualified to represent the owner and agree to do the <br />work described above in accordance w�th the rules and regulations of San Joaquin County and subject to inspection and approval. <br />David Eberhardt Jr- Operations ( <br />of Applicant - <br />v,�Sai PIAlE31ENCR0ACWMT�Rnacura Wa (ama) <br />3/9/2021 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730077 REF # <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />Shasta Ave. <br />AREA <br />1 <br />oc on QUAD <br />TYPE <br />Bell Holes (2) <br />FORMS <br />SSMNV, R-29, Trench Cut Policy <br />NOTES <br />Special Conditions <br />ermission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way h on <br />Shasta Ave approximately 502 feet/mile <br />by performing the following work (description of work): <br />437 N Shasta Ave STKO600 <br />1" Service Replacement <br />2 Cuts - 6'x7' + 3'x6' <br />Work will commence on or after 3/9/2021 for approximately so days. <br />I, the undersigned, certify that I am the finer of the respective property, or am qualified to represent the owner and agree to do the <br />work described above in accordance w�th the rules and regulations of San Joaquin County and subject to inspection and approval. <br />David Eberhardt Jr- Operations ( <br />of Applicant - <br />v,�Sai PIAlE31ENCR0ACWMT�Rnacura Wa (ama) <br />3/9/2021 <br />Date <br />