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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: O� Q 5 D-:-� <br />Date 7/2/2020 <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)464-6311 <br />(Area Code - Telephone Number) <br />deberhardt@calwater.com <br />(Email Address) <br />may <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 />9/15/2020 <br />7/7/2020 TO 9/15/2020 DRIVEWAYS: <br />Bristol Ave. <br />Stockton QUAD CC <br />Trench <br />SSMNV, R-29, Trench Cut Policy <br />Special Conditions <br />.in <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 72 feet/mile East <br />of Plymouth Rd , by performing the following work (description of work): <br />Bristol Ave <br />Main Repair "Emergency Repair" 761000 <br />1 Cut - 7'x12' <br />Work will commence on or after 7/2/2020 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 />Y.TOMisa TFA1%AME CFOA NIWTPewei*ara WON d.(=8) <br />7/2/2020 <br />Date <br />