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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <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 />State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@calwater.com <br />(Email Address) <br />�a <br />Sketch (Detailed plans may be submitted) <br />See attached <br />�18'5aq <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 />09/15/2020 <br />7/8/2020 TO 09/15/2020 DRIVEWAYS: <br />Waterloo Rd. <br />Stockton QUAD NS <br />Bell Hole <br />SS?WW, R-29, Trench Cut Policy <br />Special Conditions <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 Waterloo Rd approximately 109 feeyroile East <br />of Newport Ave , by performing the following work (description of work): <br />2579 Waterloo Rd <br />Service Repair "Emergency Repair" 763000 <br />1 Cut -2'x3' <br />Work will commence on or after <br />for approximately <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 />WOWS& TUIRAIESFNCRORCHMF T PFRMRMPIlGT1IXlA W08) <br />7/2/2020 <br />Date <br />