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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/6/2021 <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 />Sketch (Detailed plans may be submitted) <br />See attached <br /># 8542 <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 />4/1/21 <br />1/7/21 To 4/1/21 DRIVEWAYS: <br />orner ve�. <br />Stockton QUAD ES <br />Bell Hole <br />SS/WW R-29 Trench Cut Policy <br />Special <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on <br />the North side of Horner Ave approximately fib ee mile East <br />of ORO AVE. by performing the following work (description of work): <br />Install New 1" Service STK0600 <br />1 r'..4 - d'YA' <br />Work will commence on or after <br />for <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 1/6/2021 <br />Signature of Applicant - Title Da <br />Y;WONSA IEMPtAiESENMOACHWff PMW "UC00114. (NMR) <br />