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APi .CATION FOR ENCROACHMENT Pl AIT <br /> Date 19 <br /> To the San Joaquin County <br /> Highway Department <br /> Gentlemen: <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway right of way by performing the following work: <br /> (Applicant will describe here fully what he wishes to do using reverse side if necessary) <br /> Space for sketch Submit detailed plans if available. <br /> On County Highway <br /> (Applicant will state here accurately the location of the work he desires to do) <br /> and agrees to do the work in accordance with your rules and regulations and subject to your inspection <br /> and approval. <br /> Signature of Applicant <br /> Phone Number <br /> Post Office Address <br /> Permit issued: <br /> 413 PW-24 (9!84) <br />