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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/22/2023 <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 />deberhard t@calwater.00m <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br /># 8689 <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 />3/27/2023 TO 6/1/2023 DRIVEWAYS: <br />Hazelton Ave. <br />Stockton QUAD WS ' <br />(2) -Bell Holes ' <br />SS/WVV R-29 Trench Cut Policv <br />S ecial Condit ons <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North a South side of W Hazelton Ave approximately 66 feet/mile East <br />of Ventura Ave , by performing the following work (description of work): <br />Ave <br />V Service Replacement STKO600 <br />2 Cuts - 2x3'+ 2'x2' <br />commence on or after 3/22/2023 for approximately <br />60 <br />days. <br />I, the undersigned, codify 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 3/22/2023 <br />Signature of Applicant - Title Date <br />YY S s 1Flleui[sa�We a/PRxA 6s MU) <br />