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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD * <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on &ounty Kighway ULght-of-Zay on <br />the ______________ side of ___________________________________ approximately ____________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant - Title Date <br />12/17/21 <br />West Valley Construction / James Gillette <br />2655 E Miner Ave <br />Stockton, CA, 95205 <br />(408) 442-2402 <br />jgillette@wvcc.com <br />See attached Plans <br />East 99 Frontage Rd 1170 North <br />Armstrong Rd Lodi <br />Pothole to confirm existing main location, pipe type, and orientation of existing gas main and service at edge of roadway on the northbound lane. <br />This request is to Pothole for design, PG&E/WVCC will submit for encroachment permit to perform the Tie in and cut off <br />3/9/22 90 <br />James Gillette James GilletteSr. Project Managerjgillette@wvcc.com2021.12.16 16:17:31-08'00' <br />3/9/22