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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/10/2021 <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 />730077 <br />JOB # <br />APN <br />REF # <br />CR # <br /># 8551 <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET e <br />AREAoc on QUAD <br />TYPE Bell Holes x <br />FORMS R-29, Trench Cut Policy <br />NOTES �PeciaTCon /tions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -off -Way on <br />the south side of E Miner Ave approximately 26 feet/mile <br />West <br />Of N Shasta Ave I , by performing the following work (description of work): <br />zazr t miner Ave <br />Raise 2 Gate Valves to Grade 9TK0520 <br />Work will commence on or after 2/10/2021 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 />vvcreas s raimarssieuwonc�ur paanrt nreurariana� (os9w <br />2/10/2021 <br />Date <br />