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APPLICATION FOR ENCROACHMENT PERMIT �j���� <br />PLEASE PRINT: ',Jj(`� <br />Date 10/19/2020 <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) 464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@calwater.com <br />(Email Address) <br />-it <br />Sketch (Detailed plans may be submitted) <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 />5/1/2021 <br />10/21/2020 TO 5/1/2021 DRIVEWAYS: <br />Hinkley Ave. <br />Stockton QUAD ES <br />Bell Holes (2) " <br />SSMNV, R-29, Trench Cut Policy <br />Special Conditions <br />60 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of S Hinkley Ave approximately 495 feet/mile south <br />of Horner Ave , by performing the following work (description of work): <br />816 S Hinkley Ave <br />Install New 1" Service STK0600 <br />2 Cuts - 4'x4'+ 2'x2' <br />Work will commence on or after <br />approximately <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 <br />Signature of Applicant -Title <br />V1 KI56 TO IftA1E51E MOWHNIW PEWIT PP MTWd. PM) <br />10/19!2020 <br />Date <br />