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PLEASE PRINT: <br />Date 5/26/2023 <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 />APPLICATION FOR ENCROACHMENT PLRMIT <br />(City, State, Zip Code) <br />(209)464-8311 <br />(Area Code - Telephone Number) <br />deberhardt@ralwater.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br /># 8695 <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 />6/2/2023 TO 8/2/2023 DRIVEWAYS; <br />Shasta Ave. <br />Stockton QUAD NS " <br />Bell Hole k <br />SS/WW, 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 N Shasta Ave approximately 375 feet/mile North <br />of N Shasta Ave by performing the following work (description of work): <br />417 N Shasta Ave <br />Main Repair 761000 <br />1 Cut -3'x4' <br />Work will commence on or after 5/26/2023 for approximately 60 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 �iQiV 5 d TEV MTES8SMIYI NEM PFh4R d3RIG1KKlGs QlN9� <br />5/26/2023 <br />Date <br />