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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 03/30/2021 <br />To: San Joaquin County <br />Department of Public Works <br />Artlfex West, Inc. c/o Gerald "Chip" Jones <br />(Applicant Name) <br />2400 Kettner Blvd. #234 <br />(Mailing Address) <br />San Diego, CA, 92101 <br />(City, State, Zip Code) <br />(209) 460-5042 <br />(Area Code - Telephone Number) <br />glones@hacsj.org <br />(Email Address) <br />may <br />JOB# <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF# PS -2101354_ <br />193-050-25 CR # <br />6/30/2021 <br />-511/2021 TO 6/30/2021 DRIVEWAYS: <br />-Mathews Road <br />French Camp QUAD SE <br />Frontage Improvements <br />SS/WVV. R-29 Trenchcut Policy <br />Special Conditions <br />See Victory Gardens off-site Improvements for drawings. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North side of Mathews Road approximately 1,400a feel/mile west <br />Of Interstate 5 , by performing the following work (description of work): <br />This encroachment permit will include widening Mathews road and Installing concrete curb, gutter and sidewalk. <br />Work will commence on or after May 1st, 2021 for approximately 30 days. <br />I, the ersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />wor d n cribegann accordance with the rules and regulations of San Joaquin County and subject to Inspection and approval. <br />Title ` Date <br />