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APPLICATION FOR ENCROACHMENT PERMIT # 8549 <br />PLEASE PRINT: <br />Date 1/15/2021 <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 />(Detailed plans may be submitted) <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 />119120 q TO DRIVEWAYS: <br />BnstolAve. <br />QUAD CC <br />I rench <br />rench CutPolicy <br />bpecial 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 Bristol Ave approximately 63 feet(mile East <br />of Plymouth Rd by performing the following work (description of work): <br />2537 Bristol Ave <br />Main Repair <br />1 Cut - 11'X20' <br />Work will commence on or after 1/15/2021 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 riles 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:1Wp & T�WH PFAIMi APPLIGi MO X4 ] <br />1/15/2021 <br />Date <br />