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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8539 <br />Dale 10/20/2020 <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 />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 />FORMSbb/VVVV,H-29, <br />NOTES <br />OFFICE USE ONLY <br />730077 REF # <br />CR # <br />TO DRIVEWAYS: <br />University Ave. <br />Stockton QUAD <br />Bell Holes (3) <br />I rent u olcy <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 university Ave approximately 56 feetlmile East <br />of Berkley Ave by performing the following work (description of work): <br />1884 Berkley Ave (On University Ave) <br />1" Service Replacement STK0600 <br />3 Cuts - 3'x4'+ 2'x4'+ 3'x7' <br />Work will commence on or after 10/20/2020 for 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 />Y:4'OrdIS61FIAPIAIESFNCROACHI.IFNi P (IRP IWQN b%(MNa) <br />10/20/2020 <br />Date <br />