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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8547 <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@cakvater.com <br />(Email Address) <br />(Detailed plans may be <br />See attached <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMSbb7VVVV,renc <br />NOTES <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />TO DRIVEWAYS: <br />avium Sf- " <br />3tocKton QUAD <br />Bell Holes (2) <br />u o icy <br />pecia 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 E Stadium St approximately 15 feet/mile East <br />of North E St , by performing the following work (description of work): <br />1" Service Replacement STKO600 <br />2 Cuts - 4'x9' + 5'x6' <br />Work will commence on or after <br />1/15/2021 <br />tri, <br />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 />of Applicant - Title <br />Y:Wf & TBdr1ATESBd� r FP MTM-(�) <br />1/15/2021 <br />Date <br />