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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: # 8540 <br />Date 11/9/2020 <br />To: San Joaquin County <br />Department of Public Works <br />California Water Service Company <br />(Applicant <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 />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 />02/01/2021 <br />11/10/2020 TO 02/01/2021 DRIVEWAYS: <br />Coolidge Ave. <br />Stockton QUAD ES <br />Bell Holes (2) <br />SS/VVVV 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 West side of S Coolidge Ave approximately 52 feet/mile North <br />of E Washington St , by performing the following work (description of work): <br />4431 E Washington St (On S Coolidge Ave) <br />2 Cuts - 4'x5' + 3'x3' <br />Work will commence on or <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 />r:vownsa101P" EY CROnCMWFMIff,w MON da pffll) <br />111/9/2020 <br />Date <br />