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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 1/14/2021 <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 <br />(209) 4648311 <br />(Area Code - Telephone Number) <br />deberhardt@calwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br /># 8543 <br />OFFICE USE ONLY <br />JOB # 730077 REF # <br />APN CR # <br />EXP. DATE <br />VALID I! 191202 TO DRIVEWAYS: <br />STREET xX <br />atockto_ FS <br />AREA ��It F fates �2) QUAD ' <br />TYPE <br />FORMS renc <br />NOTES 6pecial Conrlq=- <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 E 6th St approximately 36 feetlmile West <br />of E 6th St <br />by performing the following work (description of work): <br />1" Service Replacement Swwo <br />2 Cuts - 5'x5' + 5'x6' <br />Work will commence on or after 1/14/2021 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 />rW9 aTBdP1ATE5 MOACNEBlT PERWA LIG Md (0&% <br />1/14/2021 <br />Date <br />