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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 />4/13/22 <br />Pacific Gas and Electric Company <br />1850 Gateway Blvd <br />Concord, CA 94520 <br />(415) 264-6935 <br />gpb4@pge.com <br />See attached plans. West Valley will perform excavation and Restoration for gas tie-in and cut off <br />and PG&E will perform the tie-in/cut off work under this encroachment permit application. <br />East 99 Frontage Road 1170 North <br />Armstrong Road Lodi <br />See attached plans. West Valley will perform excavation and Restoration for gas tie-in and cut off and PG&E will perform the tie-in/cut off work under this encroachment permit application. <br />4/18/22 90 <br />Grace Briones Digitally signed by Grace Briones <br />Date: 2022.04.13 13:17:57 -07'00'4/13/22