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PLEASE PRINT: <br />1/15/2021 <br />Date <br />APPLICATION FOR ENCROACHMENT PERMIT # 6544 <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 />JOB # <br />APN <br />EXP. DATE <br />VALID/q <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />9/2U21 TO/772T DRIVEWAYS: <br />oc on QUAD <br />roti— <br />-29, Trench Cut Policy <br />pecla Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the `Nest side of North E St approximately 102 feet/mile <br />of Roosevelt St , by performing the following work (description of work): <br />1113 North E St <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 rules and regulations of San Joaquin County and subject to inspection and approval. <br />David Eberhardt Jr - Operations Clerk 1/15/2021 <br />Signature of Applicant - Title Date <br />xvmans a ienvursacxwcxuat r�u+rt naauunw.aoc Reval <br />