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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <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 />- k1 <br />Sketch (Detailed plans may be submitted) <br />See attached <br /># 8538 <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 DRIVEWAYS: <br />12th Street <br />Stockton QUAD SS <br />Bell Holes (2) <br />SSMNV, 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 E 12th St approximately 457 feet/mile West <br />of South B St , by performing the following work (description of work): <br />1908 E 12th St <br />3/4" to 1" Service Upgrade STK0600 <br />2 Cuts - 4'x4'+ 2'x2' <br />Work will commence on or after IV/ arzuzu for approximately tiu days. <br />I, the undersigned, cerfity, 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 />YMMI38 TFAIPUTE CRWHMENT PEAKIT WUCFTION d.(01N) <br />10/19/2020 <br />Date <br />